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"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. In stage 1 shock, the patient presents with anxiety, but observations are within normal limits and blood pressure is maintained.",
"id": "10007252",
"label": "b",
"name": "1",
"picture": null,
"votes": 14
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. In stage 4 shock, patients have a heart rate over 140 bpm and are unconscious.",
"id": "10007254",
"label": "d",
"name": "4",
"picture": null,
"votes": 44
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This answer is correct. It is important to identify the stage of shock to assess the severity of the patient's condition. The patient's observations and EBL of 1600ml fall into stage 3 of shock. By stage 3, patients demonstrate hypotension and tachycardia >120 beats per minute.",
"id": "10007251",
"label": "a",
"name": "3",
"picture": null,
"votes": 112
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Stage 5 is not a recognised category of shock.",
"id": "10007255",
"label": "e",
"name": "5",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. In stage 2 shock, patients are tachycardic (>100 beats per minute) and tachypnoeic, but blood pressure is maintained.",
"id": "10007253",
"label": "c",
"name": "2",
"picture": null,
"votes": 60
}
],
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"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4053",
"name": "Shock",
"status": null,
"topic": {
"__typename": "Topic",
"id": "161",
"name": "Emergency Medicine",
"typeId": 5
},
"topicId": 161,
"totalCards": null,
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"question": "A 21-year-old man is brought into A&E by ambulance after being stabbed in the abdomen. He is conscious but mildly confused, scoring 14/15 on the Glasgow Coma Scale.\n\nObservations:\n\n* HR - 135 bpm\n\n* RR - 38/min\n\n* BP - 75/40 mmHg\n\n* Oxygen saturations - 97% on room air\n\nHis estimated blood loss (EBL) is 1600ml.\n\nWhat class of hypovolaemic shock does this patient have?",
"sbaAnswer": [
"a"
],
"totalVotes": 237,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,170 | false | 3 | null | 6,495,108 | null | false | [] | null | 13,998 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This answer is correct. The main actions of BNP are to increase sodium and water excretion and dilate blood vessels. This vasodilation results in a decrease in systemic vascular resistance.",
"id": "10007256",
"label": "a",
"name": "Reduces systemic vascular resistance",
"picture": null,
"votes": 149
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. BNP increases sodium excretion (natriuresis) in order to reduce intravascular blood volume.",
"id": "10007259",
"label": "d",
"name": "Reduces natriuresis",
"picture": null,
"votes": 30
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. BNP inhibits ADH release, which in turn reduces intravascular volume.",
"id": "10007258",
"label": "c",
"name": "Stimulates release of anti-diuretic hormone (ADH)",
"picture": null,
"votes": 28
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. BNP reduces blood pressure by reducing both systemic vascular resistance and intravascular blood volume.",
"id": "10007257",
"label": "b",
"name": "Increases blood pressure",
"picture": null,
"votes": 15
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. BNP inhibits the release of aldosterone from the adrenal glands to promote sodium and water excretion and reduce intravascular volume.",
"id": "10007260",
"label": "e",
"name": "Stimulates release of aldosterone",
"picture": null,
"votes": 24
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
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"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4582",
"name": "Heart failure",
"status": null,
"topic": {
"__typename": "Topic",
"id": "159",
"name": "Cardiovascular physiology",
"typeId": 7
},
"topicId": 159,
"totalCards": null,
"typeId": null,
"userChapter": null,
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},
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"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "13998",
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"question": "A 78-year-old woman presents to the GP with a 6-month history of worsening breathlessness on exertion and swollen ankles.\n\n\nOn examination, the jugular venous pressure is raised 3cm above normal and there is bilateral pitting oedema to mid-calf.\n\n\nN-terminal pro B-Type Naturietic Peptide (NT-proBNP) level: 860pg/L (normal: <450 pg/ml in over-75s).\n\n\nShe is referred for an echocardiogram for investigation of heart failure.\n\n\nWhich of the following is true regarding the actions of BNP?",
"sbaAnswer": [
"a"
],
"totalVotes": 246,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,171 | false | 4 | null | 6,495,108 | null | false | [] | null | 13,999 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Shortness of breath on exertion is a key feature in left-sided heart failure. It is caused by both pulmonary congestion and an inability of the left ventricle to pump enough blood to meet the increased metabolic demands of the body.",
"id": "10007262",
"label": "b",
"name": "Shortness of breath on exertion",
"picture": null,
"votes": 32
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This answer is correct. When the right ventricle cannot pump blood effectively into the pulmonary circulation, blood backs up in the venous system. This leads to congestion within the liver and portal venous system, which can result in ascites.",
"id": "10007261",
"label": "a",
"name": "Ascites",
"picture": null,
"votes": 114
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Bibasal fine crackles on auscultation of the lungs are a sign of left-sided heart failure. The build-up of blood prior to the left ventricle causes congestion in the pulmonary system. This leads to pulmonary oedema which can be heard as bibasal fine crackles on auscultation.",
"id": "10007264",
"label": "d",
"name": "Bibasal fine crackles",
"picture": null,
"votes": 46
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Orthopnoea is a symptom of left-sided heart failure due to congestion in the pulmonary system.",
"id": "10007263",
"label": "c",
"name": "Orthopnoea",
"picture": null,
"votes": 43
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Hypertension is not a sign of left or right-sided heart failure. However, chronic hypertension is a risk factor for the development of heart failure.",
"id": "10007265",
"label": "e",
"name": "Hypertension",
"picture": null,
"votes": 9
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
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"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4582",
"name": "Heart failure",
"status": null,
"topic": {
"__typename": "Topic",
"id": "159",
"name": "Cardiovascular physiology",
"typeId": 7
},
"topicId": 159,
"totalCards": null,
"typeId": null,
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},
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"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "13999",
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"likes": 0,
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"question": "An 82-year-old woman with heart failure attends the GP surgery for her annual heart failure review. Her regular medications include ramipril, bisoprolol, spironolactone, and furosemide.\n\nHer most recent echocardiogram showed both left and right sided cardiac failure.\n\nWhich of the following findings is a sign of right-sided heart failure?",
"sbaAnswer": [
"a"
],
"totalVotes": 244,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,172 | false | 5 | null | 6,495,108 | null | false | [] | null | 14,000 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. With an absence of cardiac risk factors and normal observations, ECG and troponin, a diagnosis of NSTEMI is unlikely.",
"id": "10007267",
"label": "b",
"name": "Non-ST elevation myocardial infarction (STEMI)",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Aortic sclerosis is an asymptomatic condition. It causes an ejection systolic murmur which does not radiate to the carotids. It does not typically present with loss of consciousness.",
"id": "10007268",
"label": "c",
"name": "Aortic sclerosis",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This answer is correct. The ejection systolic murmur radiating to the carotids points towards a diagnosis of aortic stenosis. Patients often remain asymptomatic for a long period before decompensating and presenting acutely with a loss of consciousness or collapse, as in this scenario.",
"id": "10007266",
"label": "a",
"name": "Aortic stenosis",
"picture": null,
"votes": 216
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. With an absence of cardiac risk factors and normal observations, ECG and troponin, a diagnosis of NSTEMI is unlikely.",
"id": "10007269",
"label": "d",
"name": "Vasovagal syncope",
"picture": null,
"votes": 13
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. The patient's capillary blood glucose is within normal limits which rules out hypoglycaemia as a cause of his syncope.",
"id": "10007270",
"label": "e",
"name": "Hypoglycaemia",
"picture": null,
"votes": 3
}
],
"comments": [],
"concept": {
"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3716",
"name": "Aortic stenosis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "134",
"name": "Cardiology",
"typeId": 7
},
"topicId": 134,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3716,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": "Aortic stenosis",
"highlights": [],
"id": "14000",
"isLikedByMe": null,
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"question": "A 64-year-old man presents to A&E after collapsing while walking to the shop, reporting breathlessness before the fall and sudden fainting. \n\n\nHe did not injure himself and currently has no symptoms. This is the first time this has happened.\n\n\n\n\n\n\nThe patient's observations are as follows: HR 68 bpm, RR 14/min, BP 125/75 mmHg, temperature 36.7°C, and oxygen saturations 98% on room air.\n\n\n\nPhysical examination is unremarkable except for an ejection systolic murmur at the right sternal edge, radiating to the carotids.\n\n\n\nHis blood tests, including full blood count, urea and electrolytes, CRP, and troponin, are normal. His capillary blood glucose is 5.6 mmol/L, and ECG shows no abnormalities. \n\n\nWhich of the following is the most likely cause of his collapse?",
"sbaAnswer": [
"a"
],
"totalVotes": 237,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,173 | false | 6 | null | 6,495,108 | null | false | [] | null | 14,001 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Alpha-2 delta-2 is the structure of haemoglobin A2 (HbA2) which constitutes around 2.5% of haemoglobin in an adult.",
"id": "10007274",
"label": "d",
"name": "Alpha-2 delta-2",
"picture": null,
"votes": 36
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. This is not a recognised structure of haemoglobin.",
"id": "10007275",
"label": "e",
"name": "Alpha-1 beta-3",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Alpha-2 beta-2 is the structure of adult haemoglobin. The most prevalent form of haemoglobin in a neonate is foetal haemoglobin (alpha-2 gamma-2). From 3-6 months after birth, foetal haemoglobin is gradually replaced by adult haemoglobin.",
"id": "10007272",
"label": "b",
"name": "Alpha-2 beta-2",
"picture": null,
"votes": 25
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Zeta-2 epsilon-2 is the structure of Gower-1 haemoglobin, which is the first type of haemoglobin produced during development in the embryonic yolk sac. After 6 weeks, foetal haemoglobin (alpha-2 gamma-2) replaces Gower-1 haemoglobin.",
"id": "10007273",
"label": "c",
"name": "Zeta-2 epsilon-2",
"picture": null,
"votes": 14
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This answer is correct. Alpha-2 gamma-2 is the structure of foetal haemoglobin which is the most prevalent form of haemoglobin in a neonate. The production of foetal haemoglobin begins in the sixth week of pregnancy and stops two to four months after birth.",
"id": "10007271",
"label": "a",
"name": "Alpha-2 gamma-2",
"picture": null,
"votes": 159
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4583",
"name": "Haemoglobin",
"status": null,
"topic": {
"__typename": "Topic",
"id": "193",
"name": "Haematological Science",
"typeId": 7
},
"topicId": 193,
"totalCards": null,
"typeId": null,
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},
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"id": "14001",
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"question": "A newborn baby undergoes blood spot (heel prick) testing as part of their routine newborn investigations to screen for inherited conditions including sickle cell disease. The results are normal.\n\nWhich of the following globin chains make up the most prevalent form of haemoglobin in a neonate?",
"sbaAnswer": [
"a"
],
"totalVotes": 237,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,174 | false | 7 | null | 6,495,108 | null | false | [] | null | 14,002 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Whilst blood group O can donate to A, B, AB, and O blood groups, as he is Rhesus +, he can only donate blood to other Rhesus + individuals and not those who are Rhesus -.",
"id": "10007277",
"label": "b",
"name": "Any blood group",
"picture": null,
"votes": 46
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. As he is Rhesus +, he can only donate to other Rhesus + individuals.",
"id": "10007279",
"label": "d",
"name": "A-, B-, AB-, O-",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. As he is Rhesus +, he can only donate to other Rhesus + individuals.",
"id": "10007278",
"label": "c",
"name": "O+ and O-",
"picture": null,
"votes": 22
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This answer is correct. Blood type O has no antigens on the cell surface and can therefore be received by any blood group. However, because he is Rhesus +, he can only donate to other Rhesus + individuals.",
"id": "10007276",
"label": "a",
"name": "A+, B+, AB+, O+",
"picture": null,
"votes": 135
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Those with blood group O have no antigens on the cell surface and can therefore donate to blood groups A, B, AB, and O. However, Rhesus + individuals can only donate to other Rhesus + individuals.",
"id": "10007280",
"label": "e",
"name": "O+ only",
"picture": null,
"votes": 26
}
],
"comments": [],
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"__typename": "Concept",
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"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3796",
"name": "Blood group compatibility",
"status": null,
"topic": {
"__typename": "Topic",
"id": "157",
"name": "Haematology",
"typeId": 7
},
"topicId": 157,
"totalCards": null,
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},
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"dislikes": 0,
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"id": "14002",
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"question": "A 32-year-old male attends his local blood donation centre to donate his blood. He is found to have blood group O+.\n\nWhich of the following blood groups can receive an O+ blood donation?",
"sbaAnswer": [
"a"
],
"totalVotes": 233,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,175 | false | 8 | null | 6,495,108 | null | false | [] | null | 14,003 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. The activated partial thromboplastin time (aPTT) is elevated in individuals with haemophilia B.",
"id": "10007285",
"label": "e",
"name": "No abnormalities detected",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This answer is correct. Haemophilia B is caused by a deficiency in factor IX, which is involved in the intrinsic coagulation pathway. The activated partial thromboplastin time (aPPT) assesses the intrinsic and common pathways and will be elevated in haemophilia B.",
"id": "10007281",
"label": "a",
"name": "Elevated activated partial thromboplastin time (aPTT)",
"picture": null,
"votes": 85
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. INR is a number derived from prothrombin time, which is normal in haemophilia A.",
"id": "10007284",
"label": "d",
"name": "High INR",
"picture": null,
"votes": 32
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. In haemophilia B, prothrombin time is typically normal. The prothrombin time is elevated in haemophilia A which is caused by a deficiency in factor VIII.",
"id": "10007283",
"label": "c",
"name": "Elevated prothrombin time (PT)",
"picture": null,
"votes": 83
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. In haemophilia B, platelet levels are typically normal.",
"id": "10007282",
"label": "b",
"name": "Low platelet count",
"picture": null,
"votes": 30
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"typeId": 7
},
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"id": "3925",
"name": "haemophilia",
"status": null,
"topic": {
"__typename": "Topic",
"id": "157",
"name": "Haematology",
"typeId": 7
},
"topicId": 157,
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"typeId": null,
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},
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"question": "A 19-year-old male with a history of Haemophilia B attends A&E with a nosebleed which is still bleeding heavily after 45 minutes. In the department, he has routine blood tests.\n\nWhich of the following is the most likely biochemical abnormality found?",
"sbaAnswer": [
"a"
],
"totalVotes": 232,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,176 | false | 9 | null | 6,495,108 | null | false | [] | null | 14,004 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. The low pH and raised PaCO2 confirms a respiratory acidosis but the normal bicarbonate levels show that there is no metabolic compensation.",
"id": "10007287",
"label": "b",
"name": "Respiratory acidosis with partial metabolic compensation",
"picture": null,
"votes": 33
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Whilst the low pH confirms acidosis, the raised PaCO2 reflects a respiratory cause. In a metabolic acidosis, the bicarbonate level is low. If there was respiratory compensation for acidosis, the PaCO2 would be low rather than high.",
"id": "10007288",
"label": "c",
"name": "Metabolic acidosis with respiratory compensation",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Whilst the low pH confirms acidosis, in metabolic acidosis the bicarbonate level would be low. The high PaCO2 reflects a respiratory cause of the acidosis.",
"id": "10007290",
"label": "e",
"name": "Metabolic acidosis with no respiratory compensation",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. The low PH demonstrates acidosis rather than alkalosis.",
"id": "10007289",
"label": "d",
"name": "Respiratory alkalosis with no metabolic compensation",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This answer is correct. The low pH confirms acidosis and the raised PaCO2 highlights that it is respiratory in origin. The bicarbonate is within normal limits which shows that there is no metabolic compensation.",
"id": "10007286",
"label": "a",
"name": "Respiratory acidosis with no metabolic compensation",
"picture": null,
"votes": 187
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
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},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4485",
"name": "Acid-Base Balance and the Arterial Blood Gas",
"status": null,
"topic": {
"__typename": "Topic",
"id": "150",
"name": "Respiratory physiology",
"typeId": 7
},
"topicId": 150,
"totalCards": null,
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"id": "14004",
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"question": "An 82-year-old woman with a history of COPD is brought into A&E with a 3-day history of fever, shortness of breath, and a worsening cough.\n\n\nObservations:\n\n\n * HR - 104bpm\n\n\n * RR - 24/min\n\n\n * BP - 135/80 mmHg\n\n\n * Temperature - 38.7 degrees\n\n\n * Oxygen saturations - 85% on room air\n\n\nArterial blood gas:\n\n\n||||\n|--------------|:-------:|------------------|\n|pH|7.28|7.35 - 7.45|\n|PaO₂|7.2 kPa|11 - 15|\n|PaCO₂|10.2 kPa|4.6 - 6.4|\n|Bicarbonate|26 mmol/L|22 - 30|\n\n\nWhich of the following describes her acid-base balance?",
"sbaAnswer": [
"a"
],
"totalVotes": 231,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,177 | false | 10 | null | 6,495,108 | null | false | [] | null | 14,005 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. The conducting bronchioles are immediately proximal to the terminal bronchioles.",
"id": "10007295",
"label": "e",
"name": "Conducting bronchioles",
"picture": null,
"votes": 20
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. The tertiary bronchi are proximal to the bronchioles",
"id": "10007294",
"label": "d",
"name": "Tertiary bronchi",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This answer is correct. The respiratory bronchioles are a continuation of the terminal bronchioles. They are approximately 0.5mm in diameter.",
"id": "10007291",
"label": "a",
"name": "Respiratory bronchioles",
"picture": null,
"votes": 65
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. The alveolar sacs are the most distal part of the respiratory tree.",
"id": "10007292",
"label": "b",
"name": "Alveolar sacs",
"picture": null,
"votes": 60
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. The alveolar ducts are distal to the respiratory bronchioles.",
"id": "10007293",
"label": "c",
"name": "Alveolar ducts",
"picture": null,
"votes": 80
}
],
"comments": [],
"concept": {
"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"id": "2693",
"pictures": [],
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},
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"demo": null,
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"id": "3777",
"name": "Structure of the respiratory tree",
"status": null,
"topic": {
"__typename": "Topic",
"id": "150",
"name": "Respiratory physiology",
"typeId": 7
},
"topicId": 150,
"totalCards": null,
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},
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"id": "14005",
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"question": "A 63-year-old woman is referred for bronchoscopy after her chest X-ray is reported as abnormal.\n\nWhich of the following is immediately distal to the terminal bronchioles in the respiratory tree?",
"sbaAnswer": [
"a"
],
"totalVotes": 229,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,178 | false | 11 | null | 6,495,108 | null | false | [] | null | 14,006 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Serratus anterior is involved in forced inspiration, where it elevates the ribcage.",
"id": "10007298",
"label": "c",
"name": "Serratus anterior",
"picture": null,
"votes": 38
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. The scalenes are involved in forced inspiration to elevate the upper ribs.",
"id": "10007297",
"label": "b",
"name": "Scalenes",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This answer is correct. The rectus abdominis is involved in forced expiration to raise intra-abdominal pressure and elevate the diaphragm.",
"id": "10007296",
"label": "a",
"name": "Rectus abdominis",
"picture": null,
"votes": 152
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Latissimus dorsi is involved in forced inspiration, where it elevates the lower ribs.",
"id": "10007299",
"label": "d",
"name": "Latissimus dorsi",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Sternocleidomastoid is involved in forced inspiration, where it elevates the lower ribs.",
"id": "10007300",
"label": "e",
"name": "Sternocleidomastoid",
"picture": null,
"votes": 17
}
],
"comments": [],
"concept": {
"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4584",
"name": "The role of the chest muscles in breathing",
"status": null,
"topic": {
"__typename": "Topic",
"id": "150",
"name": "Respiratory physiology",
"typeId": 7
},
"topicId": 150,
"totalCards": null,
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},
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"dislikes": 1,
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"highlights": [],
"id": "14006",
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"question": "A 74-year-old man attends the emergency department with an exacerbation of COPD. He is dyspnoeic and unable to talk in full sentences. On examination, it is noted that he is using accessory muscles to breathe.\n\nWhich of the following muscles is involved in forced expiration?",
"sbaAnswer": [
"a"
],
"totalVotes": 226,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,179 | false | 12 | null | 6,495,108 | null | false | [] | null | 14,007 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Asthma is an example of an obstructive lung disease where the FEV1/FVC ratio is reduced.",
"id": "10007304",
"label": "d",
"name": "Asthma",
"picture": null,
"votes": 23
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. COPD is an example of obstructive lung disease where the FEV1/FVC ratio is reduced.",
"id": "10007302",
"label": "b",
"name": "COPD",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This answer is correct. Pulmonary fibrosis is an example of restrictive lung disease, where the FEV1/FVC ratio is preserved.",
"id": "10007301",
"label": "a",
"name": "Pulmonary fibrosis",
"picture": null,
"votes": 142
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Bronchiectasis is an example of an obstructive lung disease where the FEV1/FVC ratio is reduced.",
"id": "10007303",
"label": "c",
"name": "Bronchiectasis",
"picture": null,
"votes": 21
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Chronic bronchitis is an example of an obstructive lung disease where the FEV1/FVC ratio is reduced.",
"id": "10007305",
"label": "e",
"name": "Chronic bronchitis",
"picture": null,
"votes": 31
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
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"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3726",
"name": "Spirometry",
"status": null,
"topic": {
"__typename": "Topic",
"id": "132",
"name": "Respiratory",
"typeId": 7
},
"topicId": 132,
"totalCards": null,
"typeId": null,
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"userNote": null,
"videos": []
},
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"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "14007",
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"multiAnswer": null,
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"question": "A 65-year-old woman presents to her GP with a three-month history of worsening wheeze. The GP refers her for spirometry testing.\n\nIn which of the following conditions would her FEV1/FVC ratio be preserved?",
"sbaAnswer": [
"a"
],
"totalVotes": 227,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,180 | false | 13 | null | 6,495,108 | null | false | [] | null | 14,008 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This answer is correct. The food acted as an unconditioned stimulus as it elicited salivation prior to conditioning by the sound of the bell.",
"id": "10007306",
"label": "a",
"name": "Unconditioned stimulus",
"picture": null,
"votes": 120
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. As the food caused salivation before conditioning by the sound of the bell, it is known as an unconditioned stimulus. After conditioning, the sound of the bell also elicited salivation and therefore acted as a conditioned stimulus.",
"id": "10007307",
"label": "b",
"name": "Conditioned stimulus",
"picture": null,
"votes": 62
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. A neutral stimulus would elicit no response. The food caused salivation before conditioning by the sound of the bell and therefore it is an unconditioned stimulus.",
"id": "10007308",
"label": "c",
"name": "Neutral stimulus",
"picture": null,
"votes": 21
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. The food acted as a stimulus, not a response. The response in this experiment was the salivation by the dogs.",
"id": "10007309",
"label": "d",
"name": "Unconditioned response",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. The food acted as a stimulus, not a response. The response in this experiment was the salivation by the dogs.",
"id": "10007310",
"label": "e",
"name": "Conditioned response",
"picture": null,
"votes": 18
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3781",
"name": "Classical conditioning experiments",
"status": null,
"topic": {
"__typename": "Topic",
"id": "152",
"name": "Neuroscience",
"typeId": 7
},
"topicId": 152,
"totalCards": null,
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},
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"highlights": [],
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"question": "In his classical conditioning experiment, Pavlov showed that dogs could be conditioned to salivate at the sound of a bell if the sound was repeatedly presented at the same time as food. Before conditioning, the food caused the dogs to salivate.\n\nWhich of the following roles did the food play during this experiment?",
"sbaAnswer": [
"a"
],
"totalVotes": 225,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,181 | false | 14 | null | 6,495,108 | null | false | [] | null | 14,009 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Ataxia, or co-ordination disorder, results from lesions to the cerebellum.",
"id": "10007312",
"label": "b",
"name": "Ataxia",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Retrograde amnesia, or loss of previously formed memories, arises from damage to the dorsomedial thalamus.",
"id": "10007315",
"label": "e",
"name": "Retrograde amnesia",
"picture": null,
"votes": 76
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Receptive aphasia, or difficulty comprehending written or spoken language, arises from damage to Wernicke's area in the temporal lobe.",
"id": "10007314",
"label": "d",
"name": "Receptive aphasia",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Expressive aphasia, in which patients struggle to communicate verbally despite intact comprehension, arises from damage to Broca's area in the frontal cortex.",
"id": "10007313",
"label": "c",
"name": "Expressive aphasia",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. Lesions in the hippocampus can cause anterograde amnesia, in which new events are not transferred into long-term memory.",
"id": "10007311",
"label": "a",
"name": "Anterograde amnesia",
"picture": null,
"votes": 137
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4585",
"name": "Lesions Of The Central Nervous System",
"status": null,
"topic": {
"__typename": "Topic",
"id": "152",
"name": "Neuroscience",
"typeId": 7
},
"topicId": 152,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4585,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "14009",
"isLikedByMe": null,
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"likes": 0,
"multiAnswer": null,
"pictures": [],
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"psaSectionId": null,
"qaAnswer": null,
"question": "A 47-year-old man is found to have a lesion in his hippocampus on an MRI scan.\n\nWhich of the following defects is he most likely to have presented with?",
"sbaAnswer": [
"a"
],
"totalVotes": 227,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,182 | false | 15 | null | 6,495,108 | null | false | [] | null | 14,010 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. Two consecutive GABA-mediated inhibitory signals (from the corpus striatum and internal globus pallidus) result in disinhibition of the VA/VL complex in the thalamus.",
"id": "10007316",
"label": "a",
"name": "GABA",
"picture": null,
"votes": 169
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Glutamate is an excitatory neurotransmitter. In the direct basal ganglia pathway, glutamatergic neurons are responsible for excitatory input into the corpus striatum from the cerebral cortex.",
"id": "10007318",
"label": "c",
"name": "Glutamate",
"picture": null,
"votes": 17
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. In the direct basal ganglia pathway, there is excitatory dopaminergic input from the substantia nigra pars compacta to the corpus striatum. This is not involved in disinhibition, where there are two consecutive inhibitory signals.",
"id": "10007317",
"label": "b",
"name": "Dopamine",
"picture": null,
"votes": 40
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Serotonin is not a key neurotransmitter involved in the direct basal ganglia pathway.",
"id": "10007319",
"label": "d",
"name": "Serotonin",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Noradrenaline is not a key neurotransmitter involved in the direct basal ganglia pathway.",
"id": "10007320",
"label": "e",
"name": "Noradrenaline",
"picture": null,
"votes": 1
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3823",
"name": "Basal ganglia circuits",
"status": null,
"topic": {
"__typename": "Topic",
"id": "152",
"name": "Neuroscience",
"typeId": 7
},
"topicId": 152,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3823,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "14010",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
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"question": "A 65-year-old man with a three-month history of asymmetrical tremors and bradykinesia is diagnosed with Parkinson's Disease.\n\nIn the direct pathway in the basal ganglia, which of the following inhibitory neurotransmitters is responsible for the disinhibition of the ventroanterior/ventrothalamic (VA/VL) complex in the thalamus?",
"sbaAnswer": [
"a"
],
"totalVotes": 229,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,183 | false | 16 | null | 6,495,108 | null | false | [] | null | 14,011 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Flocculonodular syndrome is most commonly seen in children with a medulloblastoma in the fourth ventricle. It is characterised by poor balance and disordered eye movements.",
"id": "10007322",
"label": "b",
"name": "Flocculonodular syndrome",
"picture": null,
"votes": 51
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Locked-in syndrome is caused by damage to the pons in the brainstem and causes paralysis.",
"id": "10007325",
"label": "e",
"name": "Locked-in syndrome",
"picture": null,
"votes": 34
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Frontal lobe syndrome arises from damage to the frontal lobe in the cerebral cortex. Symptoms typically include personality changes, inappropriate behaviour and lack of impulse control.",
"id": "10007324",
"label": "d",
"name": "Frontal lobe syndrome",
"picture": null,
"votes": 13
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Neocerebellar syndrome is caused by damage to the neocerebellum. Symptoms include slurred speech, dysmetria and dysdiadochokinesia.",
"id": "10007323",
"label": "c",
"name": "Neocerebellar syndrome",
"picture": null,
"votes": 48
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This answer is correct. Anterior lobe syndrome is caused by damage to the spinocerebellum. It is often seen in alcoholics due to malnutrition and lack of B vitamins.",
"id": "10007321",
"label": "a",
"name": "Anterior lobe syndrome",
"picture": null,
"votes": 77
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3863",
"name": "Cerebellum",
"status": null,
"topic": {
"__typename": "Topic",
"id": "152",
"name": "Neuroscience",
"typeId": 7
},
"topicId": 152,
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"question": "A 62-year-old man with a history of chronic alcohol excess is brought into A&E by ambulance after being found on the street weak, lethargic, and confused. On examination, he is ataxic and hypotonic with depressed reflexes globally. An MRI brain shows atrophy of the spinocerebellum.\n\nWhich of the following syndromes arises as a result of spinocerebellar atrophy?",
"sbaAnswer": [
"a"
],
"totalVotes": 223,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,184 | false | 17 | null | 6,495,108 | null | false | [] | null | 14,012 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. C fibres are unmyelinated and are responsible for the sensation of ongoing, lasting pain after a noxious stimulus is applied.",
"id": "10007327",
"label": "b",
"name": "C fibres",
"picture": null,
"votes": 34
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. A-alpha fibres carry information related to proprioception rather than pain.",
"id": "10007328",
"label": "c",
"name": "A-alpha fibres",
"picture": null,
"votes": 17
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. D fibres are not a recognised category of nerve fibre.",
"id": "10007330",
"label": "e",
"name": "D fibres",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This answer is correct. A-delta fibres are thinly myelinated and carry information related to pain and temperature. They are responsible for the first sensation of pain after a noxious stimulus is applied.",
"id": "10007326",
"label": "a",
"name": "A-delta fibres",
"picture": null,
"votes": 165
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Gamma fibres are efferent motor fibres rather than afferent sensory fibres.",
"id": "10007329",
"label": "d",
"name": "Gamma fibres",
"picture": null,
"votes": 6
}
],
"comments": [],
"concept": {
"__typename": "Concept",
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"__typename": "Chapter",
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"id": "3825",
"name": "Pain sensation",
"status": null,
"topic": {
"__typename": "Topic",
"id": "152",
"name": "Neuroscience",
"typeId": 7
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"question": "An 18-year-old student accidentally burns their arm when taking their pizza out of the oven.\n\nWhich of the following nerve fibres is responsible for the initial pain following a noxious stimulus?",
"sbaAnswer": [
"a"
],
"totalVotes": 229,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,185 | false | 18 | null | 6,495,108 | null | false | [] | null | 14,013 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Ethosuximide targets T-type calcium channels.",
"id": "10007334",
"label": "d",
"name": "Chloride channels",
"picture": null,
"votes": 17
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Ethosuximide targets T-type calcium channels.",
"id": "10007332",
"label": "b",
"name": "Sodium channels",
"picture": null,
"votes": 64
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This answer is correct. Ethosuximide targets T-type calcium channels. It is the anti-epileptic drug of choice in absence seizures.",
"id": "10007331",
"label": "a",
"name": "Calcium channels",
"picture": null,
"votes": 134
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Ethosuximide targets T-type calcium channels.",
"id": "10007333",
"label": "c",
"name": "Potassium channels",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Ethosuximide targets T-type calcium channels.",
"id": "10007335",
"label": "e",
"name": "Hydrogen channels",
"picture": null,
"votes": 0
}
],
"comments": [],
"concept": {
"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4586",
"name": "Ethosuximide",
"status": null,
"topic": {
"__typename": "Topic",
"id": "172",
"name": "Pharmacology of the Nervous System",
"typeId": 7
},
"topicId": 172,
"totalCards": null,
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"question": "A 24-year-old woman is diagnosed with epilepsy and is commenced on ethosuximide by her neurologist.\n\nWhich of the following ion channels does ethosuximide target?",
"sbaAnswer": [
"a"
],
"totalVotes": 223,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,186 | false | 19 | null | 6,495,108 | null | false | [] | null | 14,014 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Melatonin is a substance naturally produced in the body which promotes sleep through regulation of the sleep/wake cycle via melatonin receptors.",
"id": "10007339",
"label": "d",
"name": "Melatonin",
"picture": null,
"votes": 33
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Lorazepam is a benzodiazepine which acts to induce sleep via binding to benzodiazepine receptors on the postsynaptic GABA-A ligand-gated chloride ion channels.",
"id": "10007338",
"label": "c",
"name": "Lorazepam",
"picture": null,
"votes": 79
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This answer is correct. Zopiclone is an example of a Z-drug that binds to the alpha-1 subunit of GABA receptors to increase GABA release and induce sleep.",
"id": "10007336",
"label": "a",
"name": "Zopiclone",
"picture": null,
"votes": 96
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Diphenhydramine is a first-generation antihistamine which acts as an inverse agonist at the H1 histamine receptor. It is used for insomnia due to its sedating properties.",
"id": "10007337",
"label": "b",
"name": "Diphenhydramine",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Doxepin is a tricyclic antidepressant. One of its main side effects is sedation as it also antagonises the H1 receptor, and hence can be useful in insomnia.",
"id": "10007340",
"label": "e",
"name": "Doxepin",
"picture": null,
"votes": 6
}
],
"comments": [],
"concept": {
"__typename": "Concept",
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"__typename": "Chapter",
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"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4587",
"name": "Zopiclone",
"status": null,
"topic": {
"__typename": "Topic",
"id": "172",
"name": "Pharmacology of the Nervous System",
"typeId": 7
},
"topicId": 172,
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},
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"highlights": [],
"id": "14014",
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"question": "A 32-year-old woman attends a follow-up with her GP with a 10-day history of insomnia that is causing her significant daytime impairment. An initial trial of sleep hygiene measures has failed and the GP agrees to prescribe a short course of medication to help her sleep.\n\nWhich of the following medications induces sleep by increasing GABA release via binding to the alpha-1 subunit of GABA receptors?",
"sbaAnswer": [
"a"
],
"totalVotes": 220,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,187 | false | 20 | null | 6,495,108 | null | false | [] | null | 14,015 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This answer is correct. Citalopram is an example of a selective serotonin re-uptake inhibitor (SSRI). SSRIs have a strong affinity for serotonin receptors but a weak affinity for norepinephrine and dopamine receptors.",
"id": "10007341",
"label": "a",
"name": "Serotonin - strong affinity, norepinephrine - weak affinity, dopamine - weak affinity",
"picture": null,
"votes": 147
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Whilst SSRIs such as citalopram have a strong affinity for serotonin receptors, their affinity for norepinephrine and dopamine receptors is weak.",
"id": "10007342",
"label": "b",
"name": "Serotonin - strong affinity, norepinephrine - strong affinity, dopamine - strong affinity",
"picture": null,
"votes": 16
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. SSRIs such as citalopram have a strong affinity for serotonin receptors, but weak affinity for norepinephrine and dopamine receptors.",
"id": "10007345",
"label": "e",
"name": "Serotonin - weak affinity, norepinephrine - strong affinity, dopamine - weak affinity",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Whilst SSRIs such as citalopram have a weak affinity for norepinephrine and dopamine receptors, their affinity for serotonin receptors is strong.",
"id": "10007343",
"label": "c",
"name": "Serotonin - weak affinity, norepinephrine - weak affinity, dopamine - weak affinity",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Whilst SSRIs such as citalopram have a strong affinity for serotonin receptors, their affinity for norepinephrine and dopamine receptors is weak.",
"id": "10007344",
"label": "d",
"name": "Serotonin - strong affinity, norepinephrine - weak affinity, dopamine - strong affinity",
"picture": null,
"votes": 46
}
],
"comments": [],
"concept": {
"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4068",
"name": "Selective Serotonin Re-uptake inhibitors",
"status": null,
"topic": {
"__typename": "Topic",
"id": "172",
"name": "Pharmacology of the Nervous System",
"typeId": 7
},
"topicId": 172,
"totalCards": null,
"typeId": null,
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},
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"explanation": null,
"highlights": [],
"id": "14015",
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"question": "A 42-year-old man presents to his GP with a 4-week history of low mood, anhedonia, and feelings of guilt and hopelessness. After careful assessment, he is referred for cognitive behavioural therapy and commenced on citalopram.\n\nWhat is the relative affinity of citalopram on serotonin, norepinephrine and dopamine transporters in the brain?",
"sbaAnswer": [
"a"
],
"totalVotes": 219,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,188 | false | 21 | null | 6,495,108 | null | false | [] | null | 14,016 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. During the formation of the fracture haematoma blood from broken vessels forms a clot. This is the first stage of fracture healing following an injury.",
"id": "10007348",
"label": "c",
"name": "Fracture haematoma",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. During the bone remodelling phase, osteoclasts remodel woven bone into compact bone.",
"id": "10007347",
"label": "b",
"name": "Bone remodelling",
"picture": null,
"votes": 63
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Fracture necrosis is not a recognised stage of fracture healing.",
"id": "10007350",
"label": "e",
"name": "Fracture necrosis",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. The soft callus consists of fibrocartilage which is later replaced by a hard callus of woven bone.",
"id": "10007349",
"label": "d",
"name": "Formation of the soft callus",
"picture": null,
"votes": 51
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This answer is correct. During the formation of the hard callus osteoblasts make woven bone which replaces the soft fibrocartilage callus.",
"id": "10007346",
"label": "a",
"name": "Formation of the hard callus",
"picture": null,
"votes": 103
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
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"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4525",
"name": "Fracture healing",
"status": null,
"topic": {
"__typename": "Topic",
"id": "228",
"name": "Musculoskeletal Physiology",
"typeId": 7
},
"topicId": 228,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4525,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "14016",
"isLikedByMe": null,
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"likes": 0,
"multiAnswer": null,
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"question": "An 8-year-old boy attends the fracture clinic with his father after falling off a swing and sustaining a fracture to his left distal radius 10 days ago.\n\nDuring which of the following stages of fracture healing is fibrocartilage replaced by woven bone?",
"sbaAnswer": [
"a"
],
"totalVotes": 218,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,189 | false | 22 | null | 6,495,108 | null | false | [] | null | 14,017 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Cancellous bone is turned over 3-10 times quicker than cortical bone as it has a larger surface area and responds to stresses on the bone more rapidly.",
"id": "10007355",
"label": "e",
"name": "It has a lower rate of turnover than cortical bone",
"picture": null,
"votes": 23
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Cortical bone makes up around 80% of the total bone mass in an adult due to its high density.",
"id": "10007352",
"label": "b",
"name": "It makes up around 80% of the total bone mass in an adult",
"picture": null,
"votes": 23
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Cortical bone is arranged in osteons which are circular columns with a blood vessel running down the central Haversian canal.",
"id": "10007353",
"label": "c",
"name": "It is arranged in osteons",
"picture": null,
"votes": 26
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This answer is correct. The surface area of cancellous bone is ten-times higher than the surface area of cortical bone.",
"id": "10007351",
"label": "a",
"name": "It has a higher surface area than compact bone",
"picture": null,
"votes": 109
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Random collagen organisation is a feature of woven bone which is found in children, healing bone or pathological bone.",
"id": "10007354",
"label": "d",
"name": "It has random collagen organisation",
"picture": null,
"votes": 37
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4588",
"name": "Bone composition",
"status": null,
"topic": {
"__typename": "Topic",
"id": "228",
"name": "Musculoskeletal Physiology",
"typeId": 7
},
"topicId": 228,
"totalCards": null,
"typeId": null,
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"userNote": null,
"videos": []
},
"conceptId": 4588,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "14017",
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"likes": 0,
"multiAnswer": null,
"pictures": [],
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"qaAnswer": null,
"question": "A 55-year-old woman is diagnosed with osteoporosis after experiencing multiple fragility fractures. She asks her GP about the different types of bone.\n\nWhich of the following is true of cancellous bone?",
"sbaAnswer": [
"a"
],
"totalVotes": 218,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,190 | false | 23 | null | 6,495,108 | null | false | [] | null | 14,018 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Patients with primary hyperparathyroidism will have a raised PTH, high calcium and low phosphate. ALP may be normal or slightly elevated.",
"id": "10007359",
"label": "d",
"name": "Primary hyperparathyroidism",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. Her presentation and abnormally high ALP with otherwise normal biochemistry is characteristic of Paget's disease. None of the other options would present with an ALP so markedly raised.",
"id": "10007356",
"label": "a",
"name": "Paget's disease",
"picture": null,
"votes": 146
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Patients with chronic renal failure will have low calcium and vitamin D with elevated phosphate and PTH. ALP may be normal or slightly elevated.",
"id": "10007360",
"label": "e",
"name": "Chronic renal failure",
"picture": null,
"votes": 28
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Patients with osteoporosis typically have normal bone biochemistry.",
"id": "10007357",
"label": "b",
"name": "Osteoporosis",
"picture": null,
"votes": 17
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Whilst patients with osteomalcia may have a high ALP, they typically have low calcium, phosphate and vitamin D and an elevated PTH.",
"id": "10007358",
"label": "c",
"name": "Osteomalacia",
"picture": null,
"votes": 22
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4589",
"name": "Paget's disease of the bone",
"status": null,
"topic": {
"__typename": "Topic",
"id": "228",
"name": "Musculoskeletal Physiology",
"typeId": 7
},
"topicId": 228,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
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"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "14018",
"isLikedByMe": null,
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"likes": 0,
"multiAnswer": null,
"pictures": [],
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"psaSectionId": null,
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"question": "An 82-year-old woman presents to her GP with pain in her right hip and thigh. She describes the pain as deep and boring in nature. Her examination is normal.\n\n\nBloods:\n\n\n||||\n|--------------|:-------:|---------------|\n|Calcium|2.34 mmol/L|2.2 - 2.6|\n|Phosphate|3.2 mmol/L|0.8 - 1.5|\n|Parathyroid Hormone|1.9 pmol/L|1.6 - 8.5|\n|Vitamin D|53 nmol/L|>50|\n|Alkaline Phosphatase (ALP)|985 IU/L|25 - 115|\n\nWhich of the following conditions is she most likely to have?",
"sbaAnswer": [
"a"
],
"totalVotes": 220,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,191 | false | 24 | null | 6,495,108 | null | false | [] | null | 14,019 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Type I cartilage is not found in the ECM of cartilage.",
"id": "10007365",
"label": "e",
"name": "I",
"picture": null,
"votes": 21
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is correct. Type X collagen is present in the ECM of calcified deep layers of cartilage only.",
"id": "10007362",
"label": "b",
"name": "Type X",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Only small amounts of type IX collagen are present in the ECM of cartilage.",
"id": "10007363",
"label": "c",
"name": "Type IX",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This answer is correct. Type II collagen is the predominant type of collagen in ECM and is present in the ECM of all layers of cartilage.",
"id": "10007361",
"label": "a",
"name": "Type II",
"picture": null,
"votes": 177
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Only small amounts of type XI collagen are present in the ECM of cartilage.",
"id": "10007364",
"label": "d",
"name": "Type XI",
"picture": null,
"votes": 1
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
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"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4590",
"name": "Extracellular matrix components",
"status": null,
"topic": {
"__typename": "Topic",
"id": "181",
"name": "Structure and Function of Cells",
"typeId": 7
},
"topicId": 181,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
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},
"conceptId": 4590,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
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"question": "Which of the following is the most predominant type of collagen present in the extracellular matrix (ECM) of cartilage?",
"sbaAnswer": [
"a"
],
"totalVotes": 214,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,192 | false | 25 | null | 6,495,108 | null | false | [] | null | 14,020 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This answer is correct. The examination findings describe winging of the scapula that occurs due to paralysis of serratus anterior which normally keeps the scapula against the thoracic cage. This is caused by damage to the long thoracic nerve, which can occur during radical mastectomy.",
"id": "10007366",
"label": "a",
"name": "Long thoracic nerve",
"picture": null,
"votes": 186
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. The axillary nerve innervates the deltoid. Whilst damage would result in weakness of shoulder abduction, it would also cause loss of sensation over the regimental badge area. The axillary nerve is most commonly damaged by shoulder dislocation.",
"id": "10007367",
"label": "b",
"name": "Axillary nerve",
"picture": null,
"votes": 20
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. The radial nerve does not innervate the muscles that move the shoulder joint. Damage to the radial nerve results in wrist drop and sensory loss over the first 3.5 digits of the dorsum of the hand.",
"id": "10007370",
"label": "e",
"name": "Radial nerve",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. The spinal accessory nerve (CN XI) innervates the trapezius and sternocleidomastoid and is not commonly damaged during radical mastectomy. Whilst damage would result in weak shoulder abduction, scapular winging is much less prominent than in long thoracic nerve injury.",
"id": "10007369",
"label": "d",
"name": "Spinal accessory nerve",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. The thoracodorsal nerve innervates latissumus dorsi and damage would result in weakness of shoulder extension and adduction.",
"id": "10007368",
"label": "c",
"name": "Thoracodorsal nerve",
"picture": null,
"votes": 9
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
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"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4591",
"name": "Long thoracic nerve injury",
"status": null,
"topic": {
"__typename": "Topic",
"id": "145",
"name": "Orthopaedics",
"typeId": 7
},
"topicId": 145,
"totalCards": null,
"typeId": null,
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},
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"difficulty": 1,
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"explanation": null,
"highlights": [],
"id": "14020",
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"question": "A 62-year-old woman attends a follow-up appointment with her surgeon following a radical mastectomy for breast cancer 6 weeks ago. She complains of pain and weakness in her right shoulder.\n\nOn examination, the right scapula is visibly protruding from the back and there is weakness on flexion and abduction of the right shoulder. There are no sensory deficits.\n\nWhich of the following nerves was most likely damaged during the operation?",
"sbaAnswer": [
"a"
],
"totalVotes": 219,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,193 | false | 26 | null | 6,495,108 | null | false | [] | null | 14,021 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Damage to the musculocutaneous nerve results in weakness of arm flexion. Whilst it can become damaged in shoulder dislocation, damage to the axillary nerve is much more common.",
"id": "10007374",
"label": "d",
"name": "Musculocutaneous nerve",
"picture": null,
"votes": 15
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. The ulnar nerve can be injured in fractures to the medial epicondyle of the humerus. Damage results in atrophy of the intrinsic muscles of the hand, leading to a claw-hand appearance.",
"id": "10007375",
"label": "e",
"name": "Ulnar nerve",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This answer is correct. The axillary nerve runs inferior to the glenohumeral joint and is the nerve most at risk in a shoulder dislocation.",
"id": "10007371",
"label": "a",
"name": "Axillary nerve",
"picture": null,
"votes": 173
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. The median nerve can be injured in supracondylar fractures of the humerus. Damage results in weakness of forearm flexion.",
"id": "10007373",
"label": "c",
"name": "Median nerve",
"picture": null,
"votes": 11
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. The radial nerve is most commonly injured in fractures to the mid-shaft of the humerus. Damage results in wrist drop and weakness of arm and forearm extension.",
"id": "10007372",
"label": "b",
"name": "Radial nerve",
"picture": null,
"votes": 12
}
],
"comments": [],
"concept": {
"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4119",
"name": "Axillary nerve injury",
"status": null,
"topic": {
"__typename": "Topic",
"id": "145",
"name": "Orthopaedics",
"typeId": 7
},
"topicId": 145,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
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},
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"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "14021",
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"question": "A 22-year-old man presents to A&E with left shoulder pain and deformity following a fall onto an abducted, externally rotated arm.\n\nOn examination, there is pain and deformity of the left shoulder.\n\nWhich of the following nerves originating from the brachial plexus is most likely to have been injured?",
"sbaAnswer": [
"a"
],
"totalVotes": 213,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,194 | false | 27 | null | 6,495,108 | null | false | [] | null | 14,022 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This answer is correct. In rheumatoid arthritis, there is pannus formation where there is hyperplasia of the subintima and synovial lining of joint capsules. The pannus is full of inflammatory cells which erode the articular cartilage and underlying bone.",
"id": "10007376",
"label": "a",
"name": "Pannus formation",
"picture": null,
"votes": 141
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. In rheumatoid arthritis, there is a higher volume of synovial fluid. This is due to cytokine release which causes capillaries near the synovial surface to leak more fluid.",
"id": "10007380",
"label": "e",
"name": "Reduced volume of synovial fluid",
"picture": null,
"votes": 15
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. In rheumatoid arthritis, there is decreased synovial fluid viscosity due to the degradation of hyaluronate. The concentration of hyaluronate is proportional to the synovial fluid viscosity, so with reduced hyaluronate, the fluid is less viscous.",
"id": "10007377",
"label": "b",
"name": "Increased synovial fluid viscosity",
"picture": null,
"votes": 14
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Neutrophils are the most predominant cell type in synovial fluid in rheumatoid arthritis. Lymphocytes are the most predominant cell type in the subintima.",
"id": "10007378",
"label": "c",
"name": "Predominantly lymphocytes in synovial fluid",
"picture": null,
"votes": 41
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. In rheumatoid arthritis, there is increased osteoclast activity and reduced osteoblast activity, leading to net destruction of bone.",
"id": "10007379",
"label": "d",
"name": "Increased osteoblast activity",
"picture": null,
"votes": 1
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3975",
"name": "Rheumatoid Arthritis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "146",
"name": "Rheumatology",
"typeId": 7
},
"topicId": 146,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3975,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "14022",
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"psaSectionId": null,
"qaAnswer": null,
"question": "A 53-year-old woman is referred to a rheumatologist by her GP with suspected rheumatoid arthritis affecting the joints of her hands, feet, and knees.\n\nWhich of the following is most likely to be present in the joints of this patient?",
"sbaAnswer": [
"a"
],
"totalVotes": 212,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,195 | false | 28 | null | 6,495,108 | null | false | [] | null | 14,023 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This answer is correct. Glucagon increases lipolysis via activating hormone-sensitive lipase. This allows triglycerides to break down into glycerol and fatty acids.",
"id": "10007381",
"label": "a",
"name": "Decreases lipolysis",
"picture": null,
"votes": 95
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Glucagon inhibits glycolysis to prevent the breakdown of glucose and thus a further drop in blood glucose levels.",
"id": "10007385",
"label": "e",
"name": "Inhibits glycolysis",
"picture": null,
"votes": 56
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Glucagon increases gluconeogenesis in the liver to increase blood glucose levels.",
"id": "10007384",
"label": "d",
"name": "Increases gluconeogenesis",
"picture": null,
"votes": 23
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Glucagon decreases glycogenesis and promotes glycogenolysis to increase blood glucose levels.",
"id": "10007382",
"label": "b",
"name": "Decreases glycogenesis",
"picture": null,
"votes": 24
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Glucagon increases glycogenolysis to increase blood glucose levels.",
"id": "10007383",
"label": "c",
"name": "Increases glycogenolysis",
"picture": null,
"votes": 15
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4024",
"name": "Hormonal control of glucose metabolism",
"status": null,
"topic": {
"__typename": "Topic",
"id": "167",
"name": "Endocrine physiology",
"typeId": 7
},
"topicId": 167,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4024,
"conditions": [],
"difficulty": 1,
"dislikes": 1,
"explanation": null,
"highlights": [],
"id": "14023",
"isLikedByMe": 0,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
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"question": "A 92-year-old woman who is admitted to the elderly care ward following a fall is found by the nurse to be more drowsy than usual.\n\n\nA capillary blood glucose reading is found to be 2.1 mmol/L (3.5-5.5 mmol/L) and she is treated with 1mg intramuscular glucagon.\n\n\nWhich of the following is not a physiological action of glucagon?",
"sbaAnswer": [
"a"
],
"totalVotes": 213,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,196 | false | 29 | null | 6,495,108 | null | false | [] | null | 14,024 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Iodine deficiency is a cause of goitre but more commonly causes hypothyroidism. This patient has presented with symptoms of hyperthyroidism which is confirmed with thyroid function tests.",
"id": "10007388",
"label": "c",
"name": "Iodine deficiency",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. De Quervains thyroiditis is a cause of subacute hyperthyroidism which is associated with low TSH levels but normal levels of T4.",
"id": "10007387",
"label": "b",
"name": "De Quervain's thyroiditis",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Hashimoto's thyroiditis is a cause of hypothyroidism. This patient has presented with symptoms of hyperthyroidism which is confirmed with thyroid function tests.",
"id": "10007390",
"label": "e",
"name": "Hashimoto's thyroiditis",
"picture": null,
"votes": 13
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This answer is correct. The vignette describes classical symptoms of hyperthyroidism. The presence of a goitre and protruding eyes (proptosis) points towards a diagnosis of Grave's disease. In Grave's disease, up to 95% have anti-TSH receptor antibodies and up to 75% have anti-TPO antibodies.",
"id": "10007386",
"label": "a",
"name": "Grave's disease",
"picture": null,
"votes": 198
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. A TSH secreting pituitary adenoma is a cause of secondary hyperthyroidism, where there are high TSH levels as well as high T4 levels.",
"id": "10007389",
"label": "d",
"name": "TSH secreting pituitary adenoma",
"picture": null,
"votes": 0
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3959",
"name": "Hyperthyroidism",
"status": null,
"topic": {
"__typename": "Topic",
"id": "133",
"name": "Endocrinology",
"typeId": 5
},
"topicId": 133,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3959,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "14024",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
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"qaAnswer": null,
"question": "A 25-year-old woman presents to the GP with weight loss, irritability, and a tremor.\n\nOn examination, she is found to have a goitre and protruding eyes.\n\nBloods:\n\n* T4 - 14.3 micrograms/dL (5.0-12.0)\n* TSH - 0.2 ml/IU (0.5-5.0)\n* Anti-TSH receptor antibodies - postive\n* Anti-TPO antibodies - positive\n\nWhich of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 212,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,197 | false | 30 | null | 6,495,108 | null | false | [] | null | 14,025 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Canagliflozin is an example of an SGLT-2 inhibitor which works by increasing the excretion of glucose in the urine.",
"id": "10007394",
"label": "d",
"name": "Canagliflozin",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Metformin is an example of a biguanide which inhibits hepatic gluconeogenesis and increases insulin sensitivity in the liver and muscles.",
"id": "10007392",
"label": "b",
"name": "Metformin",
"picture": null,
"votes": 61
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Sitagliptin is an example of a DPP-4 inhibitor, which works by increasing levels of GLP-1. GLP-1 stimulates insulin release and suppresses appetite.",
"id": "10007393",
"label": "c",
"name": "Sitagliptin",
"picture": null,
"votes": 23
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Pioglizatone is an example of a PPARG (peroxisome proliferator-activated receptor gamma) agonist which works by reducing insulin resistance and increasing glucose uptake into liver and muscle",
"id": "10007395",
"label": "e",
"name": "Pioglitazone",
"picture": null,
"votes": 12
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This answer is correct. Gliclazide is an example of a sulphonylurea which binds to pancreatic beta cells to increase insulin secretion.",
"id": "10007391",
"label": "a",
"name": "Gliclazide",
"picture": null,
"votes": 112
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4071",
"name": "Anti-diabetic drugs mechanisms of action",
"status": null,
"topic": {
"__typename": "Topic",
"id": "133",
"name": "Endocrinology",
"typeId": 5
},
"topicId": 133,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4071,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "14025",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 67-year-old man with type 2 diabetes is commenced on a new anti-diabetic medication by his GP due to poor glucose control.\n\nWhich of the following anti-diabetic drugs work by increasing insulin secretion via binding to receptors on the surface of pancreatic beta cells?",
"sbaAnswer": [
"a"
],
"totalVotes": 214,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,198 | false | 31 | null | 6,495,108 | null | false | [] | null | 14,026 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Whilst sepsis will need to be excluded in hospital, this patient is more likely to have DKA due to his hyperglycaemia and high ketones in the context of type 1 diabetes.",
"id": "10007400",
"label": "e",
"name": "Sepsis",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Patients with acute appendicitis usually present with severe pain in the right iliac fossa. Appendicitis would not explain his high blood ketones.",
"id": "10007398",
"label": "c",
"name": "Acute appendicitis",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Whilst his symptoms fit with acute alcohol intoxication, this would not explain his hyperglycaemia and ketonuria.",
"id": "10007397",
"label": "b",
"name": "Alcohol intoxication",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This answer is correct. Diabetic ketoacidosis (DKA) is a medical emergency. It occurs most commonly in type 1 diabetics and presents with hyperglycaemia, ketonaemia, and acidosis. It can be precipitated by a number of causes, including an alcohol binge and forgetting to take insulin.",
"id": "10007396",
"label": "a",
"name": "Diabetic ketoacidosis",
"picture": null,
"votes": 206
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Hyperosmolar hypoglycaemic state (HHS) typically occurs in people with type 2 diabetes. Patients have very high blood sugars, but no ketones.",
"id": "10007399",
"label": "d",
"name": "Hyperosmolar hyperglycaemic state",
"picture": null,
"votes": 3
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4005",
"name": "Diabetic ketoacidosis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "133",
"name": "Endocrinology",
"typeId": 5
},
"topicId": 133,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4005,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "14026",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
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"question": "One night, an 18-year-old student with type 1 diabetes goes out clubbing with his friends. Before going out, he drinks 8 cans of beer and he accidentally forgets to take his usual insulin after dinner.\n\n\nIn the club, he starts to feel unwell. He feels dizzy and begins to vomit. His friends decide to to call an ambulance.\n\n\nThe paramedics measure his capillary blood glucose and ketones:\n\n\n * Glucose - 42 mmol/L (normal <6.1 mmol/L)\n * Ketones - 5 mmol/L (<0.6 mmol/L)\n\n\nWhich of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 210,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,199 | false | 32 | null | 6,495,108 | null | false | [] | null | 14,027 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. This patient presents with features of Cushing's syndrome which is caused by excess levels of cortisol. Excess T4 levels are seen in hyperthyroidism which causes features such as weight loss, irritability and palpitations.",
"id": "10007403",
"label": "c",
"name": "T4",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This answer is correct. This patient presents with features of Cushing's syndrome, which is caused by excess circulating cortisol.",
"id": "10007401",
"label": "a",
"name": "Cortisol",
"picture": null,
"votes": 204
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. This patient presents with features of Cushing's syndrome which is caused by excess levels of cortisol. Excess circulating growth hormone causes acromegaly.",
"id": "10007402",
"label": "b",
"name": "Growth hormone",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. This patient presents with features of Cushing's syndrome which is caused by excess levels of cortisol. High insulin levels occur in type 2 diabetes where there is insulin resistance.",
"id": "10007405",
"label": "e",
"name": "Insulin",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. This patient presents with features of Cushing's syndrome which is caused by excess levels of cortisol. Excess adrenaline can cause symptoms such as palpitations, hypertension and sweating.",
"id": "10007404",
"label": "d",
"name": "Adrenaline",
"picture": null,
"votes": 0
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
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"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3764",
"name": "Cushing's syndrome",
"status": null,
"topic": {
"__typename": "Topic",
"id": "133",
"name": "Endocrinology",
"typeId": 5
},
"topicId": 133,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3764,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "14027",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
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"question": "A 55-year-old man presents to the GP with abdominal weight gain and stretch marks on his stomach. He also reports that his face is becoming increasingly more round in shape.\n\nWhich of the following circulating hormones is most likely to be raised?",
"sbaAnswer": [
"a"
],
"totalVotes": 214,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,200 | false | 33 | null | 6,495,108 | null | false | [] | null | 14,028 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Whilst a perforated peptic ulcer can cause significant upper GI bleeds, the examination findings and chronic excess alcohol intake make a diagnosis of ruptured oesophageal varices from chronic liver disease more likely.",
"id": "10007407",
"label": "b",
"name": "Perforated peptic ulcer",
"picture": null,
"votes": 16
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Alcoholic gastritis typically presents with a long-standing history of epigastric pain and vomiting without haematemesis. The acute presentation of this patient, with signs of chronic liver disease, points more toward a diagnosis of ruptured oesophageal varices.",
"id": "10007410",
"label": "e",
"name": "Alcoholic gastritis",
"picture": null,
"votes": 34
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Gastric cancer is more commonly associated with occult upper GI bleeding rather than severe haematemesis.",
"id": "10007409",
"label": "d",
"name": "Gastric cancer",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This answer is correct. This patient presents with an upper GI bleed which is most likely secondary to ruptured oesophageal varices. His examination findings and chronic excess alcohol intake point toward a diagnosis of chronic liver disease. Portal hypertension resulting from chronic liver disease causes the development of oesophageal varices which are friable and easily rupture, causing major haemorrhage.",
"id": "10007406",
"label": "a",
"name": "Ruptured oesophageal varices",
"picture": null,
"votes": 146
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. A Mallory-Weiss tear is a superficial tear in the oesophageal lining which typically occurs after prolonged episodes of vomiting. This patient's examination findings and chronic excess alcohol intake make a diagnosis of ruptured oesophageal varices from chronic liver disease more likely.",
"id": "10007408",
"label": "c",
"name": "Mallory-Weiss tear",
"picture": null,
"votes": 7
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4592",
"name": "Variceal bleeding",
"status": null,
"topic": {
"__typename": "Topic",
"id": "136",
"name": "Gastroenterology",
"typeId": 7
},
"topicId": 136,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4592,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "14028",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
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"question": "A 58-year-old man is brought into A&E by ambulance as he is projectile vomiting blood.\n\nOn examination, he is noted to have a distended abdomen and a yellow tinge to his skin. His partner discloses that drinks 1L of whisky a day, which he has done for the last 8 years.\n\nWhich of the following is the most likely underlying pathology?",
"sbaAnswer": [
"a"
],
"totalVotes": 211,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,201 | false | 34 | null | 6,495,108 | null | false | [] | null | 14,029 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. COPD alone does not explain the deranged LFTs in this patient. COPD changes can occur early in patients with alpha-1 antitrypsin deficiency.",
"id": "10007414",
"label": "d",
"name": "Chronic obstructive pulmonary disease",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Wilson's disease is a genetic condition inherited in an autosomal recessive manner where there is abnormal accumulation of copper in tissues. It presents with Parkinsonian symptoms and psychological abnormalities. Early onset emphysema and liver cirrhosis is characteristic of alpha-1 antitrypsin deficiency.",
"id": "10007412",
"label": "b",
"name": "Wilson's disease",
"picture": null,
"votes": 30
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This answer is correct. A1AT deficiency is inherited in an autosomal dominant fashion and affects the lungs (causing emphysema) and liver (causing cirrhosis) at an early age.",
"id": "10007411",
"label": "a",
"name": "Alpha-1 antitrypsin (A1AT) deficiency",
"picture": null,
"votes": 146
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Budd-Chiari syndrome is a condition affecting the liver where there is hepatic vein obstruction. It would not explain the respiratory symptoms in this patient.",
"id": "10007415",
"label": "e",
"name": "Budd-Chiari Syndrome",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Hereditary haemochromatosis is a condition where there is an abnormal accumulation of iron in body tissues, affecting the heart, liver, and pancreas. It most commonly presents with joint pain, hyperpigmented skin, fatigue, and weight loss. Early onset emphysema and liver cirrhosis are characteristic of alpha-1 antitrypsin deficiency.",
"id": "10007413",
"label": "c",
"name": "Hereditary haemochromatosis",
"picture": null,
"votes": 17
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4593",
"name": "Alpha-1 Antitrypsin Deficiency",
"status": null,
"topic": {
"__typename": "Topic",
"id": "136",
"name": "Gastroenterology",
"typeId": 7
},
"topicId": 136,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4593,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "14029",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
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"question": "A 32-year-old woman attends her GP following spirometry and is newly diagnosed with emphysema. On further questioning, it is revealed that her father has COPD and was diagnosed with cirrhosis in his teens for which he received a liver transplant.\n\nRoutine bloods show deranged LFTs.\n\nThe GP suspects an underlying genetic disease as the cause of her symptoms.\n\nWhich of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 208,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,202 | false | 35 | null | 6,495,108 | null | false | [] | null | 14,030 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Vitamin A deficiency presents with night blindness and xerophthalmia (risking corneal ulceration).",
"id": "10007419",
"label": "d",
"name": "Vitamin A",
"picture": null,
"votes": 12
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This answer is correct. Swollen, bleeding gums and easy bruising are symptoms of scurvy which results from a deficiency in vitamin C.",
"id": "10007416",
"label": "a",
"name": "Vitamin C",
"picture": null,
"votes": 153
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Vitamin D deficiency in adults causes osteomalacia, which presents with bone pain, fractures, and muscle weakness.",
"id": "10007417",
"label": "b",
"name": "Vitamin D",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Vitamin B1 deficiency can present with Wernicke's encephalopathy (confusion, ataxia and ophthalmoplegia, wet beriberi (high output cardiac failure) or dry beriberi (peripheral neuropathy).",
"id": "10007420",
"label": "e",
"name": "Vitamin B1",
"picture": null,
"votes": 20
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Vitamin B3 deficiency causes pellagra which presents with the '3 D's' - diarrhoea, dermatitis and dementia.",
"id": "10007418",
"label": "c",
"name": "Vitamin B3",
"picture": null,
"votes": 18
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
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"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4594",
"name": "Scurvy",
"status": null,
"topic": {
"__typename": "Topic",
"id": "180",
"name": "Biochemistry",
"typeId": 7
},
"topicId": 180,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4594,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "14030",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
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"psaSectionId": null,
"qaAnswer": null,
"question": "A 45 year old man presents to his GP with swollen, bleeding gums and easy bruising. On further questioning, it is discovered that he does not eat a balanced diet.\n\nWhich of the following vitamin deficiencies is most likely in this patient?",
"sbaAnswer": [
"a"
],
"totalVotes": 212,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,203 | false | 36 | null | 6,495,108 | null | false | [] | null | 14,031 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. The collecting duct is the site of action of potassium sparing diuretics such as spironolactone and amiloride. Furosemide acts on the ascending limb of the loop of Henle.",
"id": "10007424",
"label": "d",
"name": "Collecting duct",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Furosemide acts at the ascending limb of the loop of Henle where it binds to the Na/K/Cl cotransporter.",
"id": "10007422",
"label": "b",
"name": "Loop of Henle - descending limb",
"picture": null,
"votes": 18
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. The distal convoluted tubule is the site of action of thiazide diuretics such as bendroflumethiazide. Furosemide acts on the ascending limb of the loop of Henle.",
"id": "10007423",
"label": "c",
"name": "Distal convoluted tubule",
"picture": null,
"votes": 12
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This answer is correct. Furosemide inhibits the Na/K/Cl cotransporter in the thick ascending limb of the loop of Henle. This causes more sodium, chloride, potassium, and water to be excreted in the urine.",
"id": "10007421",
"label": "a",
"name": "Loop of Henle - ascending limb",
"picture": null,
"votes": 174
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. The proximal convoluted tubule is the site of action of carbonic anhydrase inhibitors such as acetazolamide. Furosemide acts on the ascending limb of the loop of Henle.",
"id": "10007425",
"label": "e",
"name": "Proximal convoluted tubule",
"picture": null,
"votes": 8
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4018",
"name": "Furosemide",
"status": null,
"topic": {
"__typename": "Topic",
"id": "188",
"name": "Renal Pharmacology",
"typeId": 7
},
"topicId": 188,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4018,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "14031",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
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"psaSectionId": null,
"qaAnswer": null,
"question": "A 82-year-old woman with a history of heart failure attends A&E with worsening shortness of breath.\n\nOn examination, she has bibasal crackles, a raised JVP, and bilateral pitting oedema to the mid-thigh.\n\nAs part of her treatment, she is commenced on IV furosemide.\n\nWhich of the following describes the site of action of furosemide?",
"sbaAnswer": [
"a"
],
"totalVotes": 213,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,204 | false | 37 | null | 6,495,108 | null | false | [] | null | 14,032 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Age is one of the four variables used in the MDRD equation for estimating GFR. The other variables are creatinine, gender and ethnicity.",
"id": "10007428",
"label": "c",
"name": "Age",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Creatinine is one of the four variables used in the MDRD equation for estimating GFR. The other variables are age, gender and ethnicity.",
"id": "10007427",
"label": "b",
"name": "Creatinine",
"picture": null,
"votes": 20
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Ethnicity is one of the four variables used in the MDRD equation for estimating GFR. The other variables are age, gender and creatinine.",
"id": "10007430",
"label": "e",
"name": "Ethnicity",
"picture": null,
"votes": 74
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Gender is one of the four variables used in the MDRD equation for estimating GFR. The other variables are age, creatinine and ethnicity.",
"id": "10007429",
"label": "d",
"name": "Gender",
"picture": null,
"votes": 27
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This answer is correct. Body weight is included in the Cockcroft-Gault equation for calculating eGFR but is not included in the MDRD equation. The four variables in the MDRD equation are creatinine, age, gender and ethnicity.",
"id": "10007426",
"label": "a",
"name": "Body weight",
"picture": null,
"votes": 78
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3954",
"name": "Glomerular filtration rate",
"status": null,
"topic": {
"__typename": "Topic",
"id": "168",
"name": "Renal Physiology",
"typeId": 7
},
"topicId": 168,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3954,
"conditions": [],
"difficulty": 1,
"dislikes": 1,
"explanation": null,
"highlights": [],
"id": "14032",
"isLikedByMe": 0,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
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"psaSectionId": null,
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"question": "A 63-year-old man has a telephone consultation with his GP following abnormal blood results.\n\nHis estimated glomerular filtration rate (eGFR) was reported as 63 ml/min, and he is diagnosed with stage 2 chronic kidney disease.\n\nWhich of the following variables is not used in the Modification of Diet in Renal Disease (MDRD) equation for estimating renal function?",
"sbaAnswer": [
"a"
],
"totalVotes": 207,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,205 | false | 38 | null | 6,495,108 | null | false | [] | null | 14,033 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. The pudendal nerve is formed from S2-S4 nerve roots, which are the roots involved in a pudendal nerve block.",
"id": "10007435",
"label": "e",
"name": "S2-S3",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. The spinal nerves S1-S4 form the sacral plexus. The pudendal nerve is formed from S2-S4 fibres only, which are those involved in a pudendal nerve block.",
"id": "10007432",
"label": "b",
"name": "S1-S4",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This answer is correct. A pudendal nerve block is a peripheral nerve block involving the S2-S4 nerve roots. It numbs the perineum and lower vagina and is performed before episiotomy.",
"id": "10007431",
"label": "a",
"name": "S2-S4",
"picture": null,
"votes": 186
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. The nerve roots L4-S1 form the superior gluteal nerve which innervates the gluteus medius, maximus and tensor fascia lata. The nerve roots S2-S4 form the pudendal nerve, which are those involved in a pudendal nerve block.",
"id": "10007433",
"label": "c",
"name": "L4-S1",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Nerve roots from L4-S3 form the sciatic nerve which supply the majority of the lower limb. The pudendal nerve is formed from S2-S4 nerve roots, which are those involved in a pudendal nerve block.",
"id": "10007434",
"label": "d",
"name": "L4-S3",
"picture": null,
"votes": 5
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4595",
"name": "Obstetric analgesia",
"status": null,
"topic": {
"__typename": "Topic",
"id": "174",
"name": "Obstetrics",
"typeId": 7
},
"topicId": 174,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4595,
"conditions": [],
"difficulty": 1,
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"question": "A 28-year-old woman in labour requires an episiotomy to aid delivery of the foetal head. A pudendal nerve block is performed prior to making the incision.\n\nWhich of the following nerve roots are involved in a pudendal nerve block?",
"sbaAnswer": [
"a"
],
"totalVotes": 212,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,206 | false | 39 | null | 6,495,108 | null | false | [] | null | 14,034 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This answer is correct. In incomplete miscarriage, the cervical os is open, bleeding is ongoing and some foetal parts are visible in the uterus.",
"id": "10007436",
"label": "a",
"name": "Incomplete",
"picture": null,
"votes": 160
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. In a threatened miscarriage, there is light, painless bleeding and the foetus is still present in the uterus on ultrasound. The cervical os is closed. Around 25% of these women will go on to miscarry.",
"id": "10007439",
"label": "d",
"name": "Threatened",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. In a complete miscarriage, all of the foetal parts have been passed so on ultrasound the uterus is empty. The cervical os is usually closed.",
"id": "10007438",
"label": "c",
"name": "Complete",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. In a septic miscarriage, the contents of the uterus is infected causing endometritis. The uterus will be tender and there will be offensive vaginal losses.",
"id": "10007440",
"label": "e",
"name": "Septic",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. In a missed miscarriage, the uterus still contains foetal tissue but the foetus is not alive. The cervical os is closed and the woman usually has no pain or bleeding.",
"id": "10007437",
"label": "b",
"name": "Missed",
"picture": null,
"votes": 22
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
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"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3837",
"name": "Miscarriage",
"status": null,
"topic": {
"__typename": "Topic",
"id": "174",
"name": "Obstetrics",
"typeId": 7
},
"topicId": 174,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3837,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
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"highlights": [],
"id": "14034",
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"question": "A 32-year-old woman presents to the Early Pregnancy Assessment unit with vaginal bleeding and some mild abdominal cramping. She is currently 10 weeks pregnant. She otherwise feels well and has had no other symptoms or abnormal vaginal discharge.\n\nOn examination, her abdomen is non tender and speculum examination reveals an open cervical os with ongoing vaginal bleeding. There is no offensive discharge.\n\nAn ultrasound scan is performed which shows some foetal parts that are still present in the uterus, but no foetal heartbeat.\n\nWhich of the following types of miscarriage best describes this scenario?",
"sbaAnswer": [
"a"
],
"totalVotes": 201,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,207 | false | 40 | null | 6,495,108 | null | false | [] | null | 14,035 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Pre-eclampsia is a condition characterised by maternal hypertension and proteinuria. It does not typically cause vaginal bleeding. This patient's normal blood pressure and urinalysis results rule out this condition.",
"id": "10007445",
"label": "e",
"name": "Pre-eclampsia",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Miscarriage is the loss of a pregnancy before 24 weeks gestation.",
"id": "10007443",
"label": "c",
"name": "Threatened miscarriage",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Uterine rupture typically occurs during labour and causes sudden, severe abdominal pain and a non-reassuring foetal heart rate tracing on CTG.",
"id": "10007444",
"label": "d",
"name": "Uterine rupture",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Placental abruption occurs when the placenta prematurely separates from the uterine wall. It typically causes severe abdominal pain, a 'woody' uterus and painful vaginal bleeding.",
"id": "10007442",
"label": "b",
"name": "Placental abruption",
"picture": null,
"votes": 12
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This answer is correct. Placenta praevia is a condition where the placenta partially or fully covers the cervical os. It typically causes painless vaginal bleeding.",
"id": "10007441",
"label": "a",
"name": "Placenta praevia",
"picture": null,
"votes": 177
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
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"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4596",
"name": "Placenta praevia",
"status": null,
"topic": {
"__typename": "Topic",
"id": "174",
"name": "Obstetrics",
"typeId": 7
},
"topicId": 174,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4596,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "14035",
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"question": "A 28-year-old woman presents to Maternity Triage with painless vaginal bleeding. She is currently 32 weeks pregnant with her first baby.\n\nHer blood pressure is 115/77 mmHg and urinalysis is normal.\n\nShe undergoes cardiotocography (CTG) which is normal and an ultrasound scan which shows a normal foetal heartbeat and the placenta covering the cervical os.\n\nWhich of the following conditions does this patient have?",
"sbaAnswer": [
"a"
],
"totalVotes": 202,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,208 | false | 41 | null | 6,495,108 | null | false | [] | null | 14,036 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Gestational diabetes mellitus is not a recognised cause of PPH.",
"id": "10007450",
"label": "e",
"name": "Gestational diabetes mellitus",
"picture": null,
"votes": 12
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Retained placental tissue more commonly causes secondary PPH (24 hours - 12 weeks postpartum). As the placenta was complete on examination following delivery, this makes retained placental tissue unlikely.",
"id": "10007448",
"label": "c",
"name": "Retained placental tissue",
"picture": null,
"votes": 14
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Whilst she had an episiotomy, it was successfully sutured after delivery, making vaginal trauma the cause of her PPH less likely.",
"id": "10007447",
"label": "b",
"name": "Vaginal trauma",
"picture": null,
"votes": 27
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This answer is correct. Uterine atomy is the most common cause of primary PPH. This patient's advanced maternal age, long labour and first baby are all risk factors for uterine atony.",
"id": "10007446",
"label": "a",
"name": "Uterine atony",
"picture": null,
"votes": 143
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Infection more commonly causes secondary PPH (24 hours - 12 weeks postpartum).",
"id": "10007449",
"label": "d",
"name": "Infection",
"picture": null,
"votes": 4
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4597",
"name": "Postpartum haemorrhage",
"status": null,
"topic": {
"__typename": "Topic",
"id": "174",
"name": "Obstetrics",
"typeId": 7
},
"topicId": 174,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4597,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "14036",
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"question": "A 42-year-old woman delivers her baby vaginally on the labour ward. During her pregnancy, she had diet-controlled gestational diabetes mellitus, but no other issues.\n\nThis is her first baby and she was in labour for 22 hours. She required an episiotomy to aid delivery of the fetal head, which was successfully sutured after delivery. She had an active third stage of labour and delivered the placenta shortly after delivery of the baby. The midwife checks the placenta and reports that is it complete.\n\nIn the 24 hours following delivery, she loses 1200ml blood.\n\nWhich of the following is the most likely cause of her postpartum haemorrhage (PPH)?",
"sbaAnswer": [
"a"
],
"totalVotes": 200,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,209 | false | 42 | null | 6,495,108 | null | false | [] | null | 14,037 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Cleavage of the embryo at the blastocyst stage (days 4-8) results in monozygotic twins that are monochorionic and diamniotic.",
"id": "10007452",
"label": "b",
"name": "Blastocyst",
"picture": null,
"votes": 75
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Cleavage of the embryo when the embryonic disc has formed (days 13-15) results in conjoined twins.",
"id": "10007454",
"label": "d",
"name": "Formed embryonic disc",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Cleavage of the embryo at the implanted blastocyst stage (days 8-13) results in monozygotic twins that are monochorionic and monoamniotic.",
"id": "10007453",
"label": "c",
"name": "Implanted blastocyst",
"picture": null,
"votes": 23
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This answer is correct. Cleavage of the embryo at the morula stage (day 1-3) results in monozygotic twins that are dichorionic and diamniotic.",
"id": "10007451",
"label": "a",
"name": "Morula",
"picture": null,
"votes": 45
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Division of the zygote at fertilisation is normal and does not result in twins.",
"id": "10007455",
"label": "e",
"name": "Fertilisation",
"picture": null,
"votes": 48
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4598",
"name": "Twins",
"status": null,
"topic": {
"__typename": "Topic",
"id": "175",
"name": "Reproductive Physiology",
"typeId": 7
},
"topicId": 175,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4598,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
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"id": "14037",
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"multiAnswer": null,
"pictures": [],
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"question": "A 24-year-old woman is 21 weeks pregnant with monozygotic twins.\n\nAn ultrasound scan reveals that the twins are dichorionic and diamniotic.\n\nAt what stage of development did the zygote separate?",
"sbaAnswer": [
"a"
],
"totalVotes": 201,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,210 | false | 43 | null | 6,495,108 | null | false | [] | null | 14,038 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Fibroids are a recognised cause of infertility. Large fibroids inside the uterus can prevent sperm reaching the egg, or prevent a fertilised egg from implanting in the uterus.",
"id": "10007460",
"label": "e",
"name": "Fibroids",
"picture": null,
"votes": 27
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. PCOS is a recognised cause of infertility as it causes infrequent ovulations which reduces the chance of conception.",
"id": "10007457",
"label": "b",
"name": "Polycystic ovarian syndrome (PCOS)",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Endometriosis is a recognised cause of infertility. In endometriosis, endometrial tissue grows in abnormal places such as the ovaries or fallopian tubes which can block the fallopian tubes or form scar tissue that makes it harder to conceive.",
"id": "10007458",
"label": "c",
"name": "Endometriosis",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This answer is correct. Prior use of the combined oral contraceptive pill does not affect fertility, even if it was taken for many years. Once a woman stops taking the combined pill, her fertility returns to normal.",
"id": "10007456",
"label": "a",
"name": "Prior long term combined oral contraceptive pill use",
"picture": null,
"votes": 166
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Pelvic inflammatory disease is a recognised cause of infertility as it can cause the formation of scar tissue in the fallopian tube which makes it harder for the sperm and egg to meet.",
"id": "10007459",
"label": "d",
"name": "Pelvic inflammatory disease",
"picture": null,
"votes": 6
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4030",
"name": "Fertility",
"status": null,
"topic": {
"__typename": "Topic",
"id": "175",
"name": "Reproductive Physiology",
"typeId": 7
},
"topicId": 175,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4030,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "14038",
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"psaSectionId": null,
"qaAnswer": null,
"question": "A 36-year-old woman attends the fertility clinic with her partner after struggling to conceive for three years.\n\nWhich of the following is not a recognised cause of infertility?",
"sbaAnswer": [
"a"
],
"totalVotes": 206,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,211 | false | 44 | null | 6,495,108 | null | false | [] | null | 14,039 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Systemic vascular resistance decreases by around 50% during pregnancy which contributes to the lowering of blood pressure.",
"id": "10007462",
"label": "b",
"name": "Increased systemic vascular resistance",
"picture": null,
"votes": 25
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. In pregnancy, there is a dilutional anaemia as the haemoglobin concentration drops due to the increase in plasma volume.",
"id": "10007465",
"label": "e",
"name": "Increased haemoglobin concentration",
"picture": null,
"votes": 32
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This answer is correct. An increase in heart rate of around 25% is a normal physiological response in pregnancy. Increases in both heart rate and stroke volume contribute to an increase in cardiac output.",
"id": "10007461",
"label": "a",
"name": "Increase in heart rate",
"picture": null,
"votes": 93
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Blood pressure decreases in early pregnancy and is restored to pre-pregnancy levels in the late second trimester. Blood pressure should not rise past that of the pre-pregnant state; new-onset hypertension in pregnancy is always abnormal.",
"id": "10007463",
"label": "c",
"name": "Increase in blood pressure",
"picture": null,
"votes": 42
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. In pregnancy, the plasma volume increases by up to 45% compared to the non-pregnant state.",
"id": "10007464",
"label": "d",
"name": "Decreased plasma volume",
"picture": null,
"votes": 13
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4581",
"name": "Maternal Physiology",
"status": null,
"topic": {
"__typename": "Topic",
"id": "175",
"name": "Reproductive Physiology",
"typeId": 7
},
"topicId": 175,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4581,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "14039",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
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"question": "A 23-year-old woman attends a booking appointment with her midwife shortly after finding out she is pregnant. At the appointment, the midwife measures her observations.\n\nWhich of the following is a normal physiological cardiovascular adaptation in pregnancy?",
"sbaAnswer": [
"a"
],
"totalVotes": 205,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,212 | false | 45 | null | 6,495,108 | null | false | [] | null | 14,040 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Faecal incontinence is common in functional constipation where children retain stool, leading to overflow diarrhoea and soiling.",
"id": "10007470",
"label": "e",
"name": "Faecal incontinence",
"picture": null,
"votes": 24
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Children with functional constipation often have ongoing symptoms for many weeks or months. A history of constipation in the neonatal period is more concerning and points towards an underlying organic cause.",
"id": "10007468",
"label": "c",
"name": "Ongoing constipation for 6 months",
"picture": null,
"votes": 35
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This answer is correct. Faltering growth in children is always a red flag. Children with constipation and faltering growth are more likely to have an underlying organic disease that is causing the constipation.",
"id": "10007466",
"label": "a",
"name": "Faltering growth",
"picture": null,
"votes": 95
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. An empty rectum on PR examination is more likely to indicate an underlying organic disease, such as Hirshprung's disease.",
"id": "10007467",
"label": "b",
"name": "Stool in the rectum on PR exam",
"picture": null,
"votes": 20
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. The presence of a distended abdomen in a child with constipation is more concerning and points towards an underlying organic cause.",
"id": "10007469",
"label": "d",
"name": "Non-distended abdomen",
"picture": null,
"votes": 30
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4599",
"name": "Constipation in children",
"status": null,
"topic": {
"__typename": "Topic",
"id": "153",
"name": "Paediatrics",
"typeId": 7
},
"topicId": 153,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4599,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "14040",
"isLikedByMe": null,
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"likes": 0,
"multiAnswer": null,
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"question": "A 6-year-old girl is brought to the GP with her mother who is concerned that she only opens her bowels once or twice a week. This has been the case for the last 6 months.\n\nWhich of the following findings indicates the presence of an underlying organic cause of her constipation?",
"sbaAnswer": [
"a"
],
"totalVotes": 204,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,213 | false | 46 | null | 6,495,108 | null | false | [] | null | 14,041 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Glutaric aciduria type 1 (GA1) is one of the 9 conditions screened for in the newborn heel prick test. Babies found to have high acylcarnitine levels on heel prick testing are likely to have GA1. High levels of immunoreactive trypsin are found in babies with cystic fibrosis.",
"id": "10007475",
"label": "e",
"name": "Glutaric aciduria type 1",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Congenital hypothyroidism is one of the 9 conditions screened for in the newborn heel prick test. Babies found to have high TSH levels on heel prick testing are likely to have congenital hypothyroidism. High levels of immunoreactive trypsin are found in babies with cystic fibrosis.",
"id": "10007472",
"label": "b",
"name": "Congenital hypothyroidism",
"picture": null,
"votes": 14
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Phenylketonuria (PKU) is one of the 9 conditions screened for in the newborn heel prick test. Babies found to have high phenylalanine levels on heel prick testing are likely to have PKU. High levels of immunoreactive trypsin are found in babies with cystic fibrosis.",
"id": "10007473",
"label": "c",
"name": "Phenylketonuria",
"picture": null,
"votes": 67
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Maple syrup urine disease (MSUD) is one of the 9 conditions screened for in the newborn heel prick test. Babies found to have high leucine levels on heel prick testing are likely to have MSUD. High levels of immunoreactive trypsin are found in babies with cystic fibrosis.",
"id": "10007474",
"label": "d",
"name": "Maple syrup urine disease",
"picture": null,
"votes": 21
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This answer is correct. Cystic fibrosis is one of the 9 conditions screened for in the newborn heel prick test. Babies found to have high immunoreactive trypsin on heel prick testing are likely to have cystic fibrosis.",
"id": "10007471",
"label": "a",
"name": "Cystic fibrosis",
"picture": null,
"votes": 87
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4600",
"name": "Metabolic conditions (Newborn Screen)",
"status": null,
"topic": {
"__typename": "Topic",
"id": "153",
"name": "Paediatrics",
"typeId": 7
},
"topicId": 153,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
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},
"conceptId": 4600,
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"difficulty": 1,
"dislikes": 0,
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"highlights": [],
"id": "14041",
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"question": "A newborn baby is found to have elevated levels of immunoreactive trypsin on his heel prick test.\n\nWhich of the following diseases is the child most likely to have?",
"sbaAnswer": [
"a"
],
"totalVotes": 198,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,214 | false | 47 | null | 6,495,108 | null | false | [] | null | 14,042 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This answer is correct. Coarctation of the aorta is an acyanotic congenital heart condition where there is narrowing of the aortic arch. It presents with a systolic murmur, differences in oxygen saturations between the upper and lower limb, and weak or absent femoral pulses.",
"id": "10007476",
"label": "a",
"name": "Coarctation of the aorta",
"picture": null,
"votes": 151
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Tetralogy of Fallot is a cyanotic congenital heart condition that causes cyanosis and low oxygen saturations in all four limbs. It does not cause absent femoral pulses. It is usually identified on antenatal scans.",
"id": "10007478",
"label": "c",
"name": "Tetralogy of Fallot",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Aortic valve stenosis restricts blood flow from the left ventricle to the aorta. Whilst it causes a systolic murmur, aortic stenosis does not account for the absent femoral pulses and difference in oxygen saturation between the upper and lower limbs.",
"id": "10007477",
"label": "b",
"name": "Aortic valve stenosis",
"picture": null,
"votes": 15
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Ventricular septal defects are often asymptomatic but can produce a systolic murmur. However, it does not cause differences in oxygen saturation between the upper and lower limbs or absent femoral pulses.",
"id": "10007480",
"label": "e",
"name": "Ventricular septal defect",
"picture": null,
"votes": 18
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Transposition of the great arteries is a cyanotic congenital heart condition that causes cyanosis and low oxygen saturations in all four limbs. It does not cause absent femoral pulses. It is usually identified on antenatal scans.",
"id": "10007479",
"label": "d",
"name": "Transposition of the great arteries",
"picture": null,
"votes": 13
}
],
"comments": [],
"concept": {
"__typename": "Concept",
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"__typename": "Chapter",
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"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4601",
"name": "Coarctation of aorta",
"status": null,
"topic": {
"__typename": "Topic",
"id": "153",
"name": "Paediatrics",
"typeId": 7
},
"topicId": 153,
"totalCards": null,
"typeId": null,
"userChapter": null,
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},
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"difficulty": 1,
"dislikes": 0,
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"highlights": [],
"id": "14042",
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"question": "A one day old baby has his routine newborn examination by the paediatric registrar before being discharged home.\n\nExamination findings:\n\n* Upper limb oxygen saturation - 99%\n* Lower limb oxygen saturation - 91%\n* Femoral pulses - not palpable\n* Auscultation of heart - systolic murmur present\n\nWhich of the following congenital heart conditions is this baby most likely to have?",
"sbaAnswer": [
"a"
],
"totalVotes": 207,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,215 | false | 48 | null | 6,495,108 | null | false | [] | null | 14,043 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. The influenza vaccine is given as a nasal spray annually to children from 2 years to the end of primary school.",
"id": "10007484",
"label": "d",
"name": "Influenza",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Two doses of the MMR vaccine are given at 1 year and 3 years and 4 months (preschool).",
"id": "10007483",
"label": "c",
"name": "Measles, mumps and rubella (MMR)",
"picture": null,
"votes": 97
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This answer is correct. Two doses of the rotavirus vaccine are given at 8 and 12 weeks of age.",
"id": "10007481",
"label": "a",
"name": "Rotavirus",
"picture": null,
"votes": 74
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. One dose of the meningitis ACWY vaccine is given to children at 14 years of age.",
"id": "10007485",
"label": "e",
"name": "Meningitis ACWY",
"picture": null,
"votes": 11
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Three doses of the meningitis B vaccine are given at 8 weeks, 16 weeks and 1 year.",
"id": "10007482",
"label": "b",
"name": "Meningitis",
"picture": null,
"votes": 21
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
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"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4602",
"name": "Vaccinations",
"status": null,
"topic": {
"__typename": "Topic",
"id": "153",
"name": "Paediatrics",
"typeId": 7
},
"topicId": 153,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4602,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "14043",
"isLikedByMe": null,
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"likes": 0,
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"question": "A 12-week-old girl is brought to the GP by her father for her routine immunisations.\n\nAccording to the UK immunisation schedule, which of the following vaccines should be given at 12 weeks?",
"sbaAnswer": [
"a"
],
"totalVotes": 212,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,216 | false | 49 | null | 6,495,108 | null | false | [] | null | 14,044 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Whilst babies with Down's Syndrome are at increased risk of Hirschprung's disease, it typically presents with delayed passage of meconium after birth rather than vomiting.",
"id": "10007488",
"label": "c",
"name": "Hirschprung's disease",
"picture": null,
"votes": 39
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This answer is correct. Babies with Down's Syndrome are at increased risk of pyloric stenosis. It presents with projectile vomiting and inadequate weight gain. The hypertrophied pylorus can sometimes be felt as a hard, olive-shaped lump on examination of the abdomen.",
"id": "10007486",
"label": "a",
"name": "Pyloric stenosis",
"picture": null,
"votes": 82
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Whilst babies with Down's Syndrome are at increased risk of duodenal atresia, it typically presents with projectile vomiting within the first 24-36 hours after birth. Projectile vomiting at 4 weeks, with a palpable abdominal mass, is more likely to be pyloric stenosis.",
"id": "10007487",
"label": "b",
"name": "Duodenal atresia",
"picture": null,
"votes": 81
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Whilst babies with Down's Syndrome are at increased risk of hypothyroidism, it does not present with vomiting, making this diagnosis unlikely.",
"id": "10007490",
"label": "e",
"name": "Hypothyroidism",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Whilst babies with Down's Syndrome are at increased risk of GORD, the presence of a palpable abdominal mass and faltering growth make a diagnosis of pyloric stenosis more likely.",
"id": "10007489",
"label": "d",
"name": "Gastroesophageal reflux disease (GORD)",
"picture": null,
"votes": 7
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4603",
"name": "Down's Syndrome",
"status": null,
"topic": {
"__typename": "Topic",
"id": "153",
"name": "Paediatrics",
"typeId": 7
},
"topicId": 153,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4603,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "14044",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
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"pictures": [],
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"qaAnswer": null,
"question": "A 4-week-old boy with Down's Syndrome is brought to children's A&E by his mother as she is concerned that he is projectile vomiting after all of his feeds and not gaining weight.\n\nWhen his length and weight are plotted on a growth chart, it is noted that he has fallen by two centile lines.\n\nOn examination, a hard olive-sized lump is felt in the child's upper abdomen.\n\nWhich of the following conditions is the most likely cause of his vomiting?",
"sbaAnswer": [
"a"
],
"totalVotes": 209,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,217 | false | 50 | null | 6,495,108 | null | false | [] | null | 14,045 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Whilst adenovirus can cause bronchiolitis, it is more commonly caused by respiratory syncytial virus.",
"id": "10007494",
"label": "d",
"name": "Adenovirus",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This answer is correct. Respiratory syncytial virus is the most common pathogen causing bronchiolitis.",
"id": "10007491",
"label": "a",
"name": "Respiratory syncytial virus",
"picture": null,
"votes": 175
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Whilst human metapneumovirus can cause bronchiolitis, it is more commonly caused by respiratory syncytial virus.",
"id": "10007495",
"label": "e",
"name": "Human metapneumovirus",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Whilst rhinovirus can cause bronchiolitis, it is more commonly caused by respiratory syncytial virus.",
"id": "10007493",
"label": "c",
"name": "Rhinovirus",
"picture": null,
"votes": 14
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. The parainfluenza virus can cause bronchiolitis, but less commonly than respiratory syncytial virus. The parainfluenza virus is the most common pathogen causing croup.",
"id": "10007492",
"label": "b",
"name": "Parainfluenza virus",
"picture": null,
"votes": 11
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
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"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4400",
"name": "Bronchiolitis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "153",
"name": "Paediatrics",
"typeId": 7
},
"topicId": 153,
"totalCards": null,
"typeId": null,
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"userNote": null,
"videos": []
},
"conceptId": 4400,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
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"likes": 0,
"multiAnswer": null,
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"psaSectionId": null,
"qaAnswer": null,
"question": "A 3-month-old girl is admitted to the Paediatrics ward with difficulty breathing and wheezing. She is diagnosed with bronchiolitis.\n\nWhich of the following is the most likely causative pathogen?",
"sbaAnswer": [
"a"
],
"totalVotes": 209,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,338 | false | 1 | null | 6,495,113 | null | false | [] | null | 14,046 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A keloid scar would present as a hard smooth growth at a site of trauma. They can form on any body part but are most commonly found after injury to the upper chest, sternum, shoulder, face, earlobes, and lower legs.",
"id": "10007500",
"label": "e",
"name": "Keloid scar",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Features of malignant melanoma follow the ABCDE pattern. Look for a lesion with asymmetry, a scalloped border, multiple colours, a diameter greater than 6mm, and a lesion that evolves over time.",
"id": "10007498",
"label": "c",
"name": "Malignant Melanoma",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the classic description of a basal cell carcinoma (BCC), the most common type of skin cancer. Look out for a skin-coloured or pink nodule with a central depression, pearly rolled edge, and surface telangiectasia. BCC's are unlikely to cause any pain or bleeding and are very slow growing. They are usually located on sun-exposed areas of skin, hence the lesion in this question appearing on the patient's neck.",
"id": "10007496",
"label": "a",
"name": "Basal cell carcinoma",
"picture": null,
"votes": 234
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Actinic keratoses are premalignant lesions that often appear before the development of squamous cell carcinoma. Unlike BCCs, they present as a thickened papule or plaque with surrounding erythematous skin. They have a rough warty surface and can cause pruritus. They are also typically found on sun-exposed skin.",
"id": "10007499",
"label": "d",
"name": "Actinic keratosis",
"picture": null,
"votes": 17
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Squamous cell carcinomas (SCCs) appear as irregular, ill-defined red nodules. They often appear scaly and ulcerated. They can cause pain and bleeding and can grow over weeks to months. Similarly to BCC's, they typically appear on sun-exposed skin such as on the face, scalp, ears, and hands.",
"id": "10007497",
"label": "b",
"name": "Squamous cell carcinoma",
"picture": null,
"votes": 47
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4604",
"name": "Basal Cell Carcinoma (BCC)",
"status": null,
"topic": {
"__typename": "Topic",
"id": "144",
"name": "Dermatology",
"typeId": 7
},
"topicId": 144,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4604,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "14046",
"isLikedByMe": null,
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"qaAnswer": null,
"question": "A 70-year-old male attends the GP as he is worried about a new skin lesion. He has a small pink nodule with a central depression on the side of his neck. He does not report any pain or bleeding from the lesion. On closer examination, you can see telangiectasia on the surface of the nodule.\n\nWhich of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 310,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,339 | false | 2 | null | 6,495,113 | null | false | [] | null | 14,047 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Acne is an inflammatory disease of the pilosebaceous unit (which is made up of the hair follicle and sebaceous gland). Acne vulgaris is not an autoimmune disease and therefore is not the most likely condition to appear alongside alopecia areata.",
"id": "10007503",
"label": "c",
"name": "Acne Vulgaris",
"picture": null,
"votes": 24
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Osteoarthritis results from the gradual wear and tear of joints over time. It is not an autoimmune disease and therefore is not the most likely condition to appear alongside alopecia areata.",
"id": "10007504",
"label": "d",
"name": "Osteoarthritis",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Glaucoma is an optic neuropathy that causes the death of optic nerve fibres. It is not an autoimmune condition and therefore is not the most likely condition to appear alongside alopecia areata.",
"id": "10007505",
"label": "e",
"name": "Glaucoma",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient shows well-defined patches of hair loss, with the surrounding hairs showing characteristic ‘exclamation mark’ hairs. This is a classic picture of alopecia areata, an autoimmune disease. This question asks which other condition is likely to appear alongside alopecia areata. The answer is another autoimmune disease, in this case hypothyroidism, as patients with one autoimmune disease are more likely to develop additional autoimmune disorders.",
"id": "10007501",
"label": "a",
"name": "Hypothyroidism",
"picture": null,
"votes": 259
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "In type 2 diabetes mellitus, repeated excess exposure to glucose leads to deficient insulin secretion from the pancreatic beta cells. This is not an autoimmune condition and therefore is not the most likely condition to occur alongside alopecia areata.",
"id": "10007502",
"label": "b",
"name": "Type 2 Diabetes Mellitus",
"picture": null,
"votes": 13
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4605",
"name": "Alopecia",
"status": null,
"topic": {
"__typename": "Topic",
"id": "144",
"name": "Dermatology",
"typeId": 7
},
"topicId": 144,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4605,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "14047",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
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"psaSectionId": null,
"qaAnswer": null,
"question": "A 21-year-old female attends the GP surgery as she has noticed well-defined patches of hair loss across her scalp. On closer examination, you notice the surrounding hairs are narrower near the base, forming an exclamation mark shape.\n\nWhich of the following other conditions is this patient most likely to have?",
"sbaAnswer": [
"a"
],
"totalVotes": 299,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,340 | false | 3 | null | 6,495,113 | null | false | [] | null | 14,048 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Duke’s classification is used for the staging of colorectal cancer. It measures the depth of invasion of the tumour through the mucosa and bowel wall. It is not a helpful prognostic indicator of malignant melanoma.",
"id": "10007508",
"label": "c",
"name": "Duke’s classification",
"picture": null,
"votes": 31
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Histology is used to diagnose malignant melanoma, and Breslow thickness is used to measure the depth of the tumour. Breslow thickness is a strong predictor of outcome for malignant melanoma. If Breslow thickness is more than 1mm, a sentinel node biopsy should be carried out which will look for any evidence of metastases and the stage of the cancer.",
"id": "10007506",
"label": "a",
"name": "Breslow thickness",
"picture": null,
"votes": 201
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Ann Arbor staging is the system used to stage both Hodgkin's and non-Hodgkin’s lymphoma. It is not a helpful prognostic indicator of malignant melanoma.",
"id": "10007510",
"label": "e",
"name": "Ann Arbor staging",
"picture": null,
"votes": 24
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The Barthel index is a scale that measures a patient’s functional independence by looking at their ability to perform Activities of Daily Living (ADL’s). Although a higher level of functional independence is generally associate with better outcomes, it is not a specific prognostic indicator in malignant melanoma.",
"id": "10007507",
"label": "b",
"name": "Barthel index",
"picture": null,
"votes": 16
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The Waterlow score is used to estimate a patient’s risk of developing a pressure sore. It is not a helpful prognostic indicator of malignant melanoma.",
"id": "10007509",
"label": "d",
"name": "Waterlow score",
"picture": null,
"votes": 11
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
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"demo": null,
"entitlement": null,
"id": "4606",
"name": "ABCDE assessment of malignant melanoma",
"status": null,
"topic": {
"__typename": "Topic",
"id": "162",
"name": "General practice",
"typeId": 5
},
"topicId": 162,
"totalCards": null,
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"userNote": null,
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"question": "A 55-year-old female is diagnosed with a malignant melanoma after noticing a brown asymmetrical lesion on the sole of her foot. She is keen to learn more about her prognosis.\n\nWhich of the following is the primary prognostic indicator of melanoma?",
"sbaAnswer": [
"a"
],
"totalVotes": 283,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,341 | false | 4 | null | 6,495,113 | null | false | [] | null | 14,049 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Type 3 hypersensitivity reactions are immune complex-mediated. Examples of Type 3 Hypersensitivity reactions include serum sickness, post-streptococcal glomerulonephritis, and extrinsic allergic alveolitis. By contrast, symptoms of anaphylaxis as demonstrated by this patient are characteristic of a type 1 hypersensitivity reaction.",
"id": "10007512",
"label": "b",
"name": "Type 3",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Type 4 hypersensitivity reactions are also known as delayed hypersensitivity. They are T cell-mediated rations. Examples of type 4 include TB, graft versus host disease, allergic contact dermatitis, scabies, Multiple sclerosis, and Guillain-Barré syndrome. By contrast, symptoms of anaphylaxis as demonstrated by this patient are characteristic of a type 1 hypersensitivity reaction.",
"id": "10007515",
"label": "e",
"name": "Type 4",
"picture": null,
"votes": 15
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This question describes a patient with clinical features of anaphylaxis: swollen lips and tongue, wheezing, shortness of breath, tachycardia, hypotension, urticaria, pruritus, and flushed skin. Anaphylaxis is an example of a Type 1 hypersensitivity reaction. These reactions occur when the antigen reacts with IgE bound to mast cells. Another example of a type 1 hypersensitivity reaction is atopy (asthma, eczema, and hay fever).",
"id": "10007511",
"label": "a",
"name": "Type 1",
"picture": null,
"votes": 259
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Examples of type 5 hypersensitivity reactions include Grave’s disease and myasthenia gravis. These types of reactions occur when antibodies recognize and bind to cell surface receptors, which causes either stimulation or blockage of ligand binding. By contrast, symptoms of anaphylaxis as demonstrated by this patient are characteristic of a type 1 hypersensitivity reaction.",
"id": "10007514",
"label": "d",
"name": "Type 5",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Type 2 hypersensitivity reactions are cell-bound. They occur when IgG or IgM binds to a cell surface antigen. Examples of type 2 hypersensitivity reactions include autoimmune haemolytic anaemia, Goodpasture’s syndrome, and rheumatic fever. By contrast, symptoms of anaphylaxis as demonstrated by this patient are characteristic of a type 1 hypersensitivity reaction.",
"id": "10007513",
"label": "c",
"name": "Type 2",
"picture": null,
"votes": 15
}
],
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},
"chapterId": 2693,
"demo": null,
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"id": "4091",
"name": "Hypersensitivity reactions",
"status": null,
"topic": {
"__typename": "Topic",
"id": "158",
"name": "Immunology",
"typeId": 7
},
"topicId": 158,
"totalCards": null,
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"question": "A 16-year-old male attends the emergency department with lip and tongue swelling that began 20 minutes ago. He is in noticeable distress and is finding it increasingly more difficult to breathe. On examination, his heart rate is 120, and his blood pressure 89/60.\n\nWhich type of hypersensitivity reaction is he experiencing?",
"sbaAnswer": [
"a"
],
"totalVotes": 296,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,342 | false | 5 | null | 6,495,113 | null | false | [] | null | 14,050 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Neutrophils are the most abundant of white blood cells and play an important role in fighting early stages of bacterial infections. They kill rapidly dividing bacteria. They are phagocytic and produce cytokines.",
"id": "10007517",
"label": "b",
"name": "Neutrophils",
"picture": null,
"votes": 67
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Eosinophils defend against protozoan and parasitic infections. They would not be responsible for increasing body temperature in this case.",
"id": "10007520",
"label": "e",
"name": "Eosinophils",
"picture": null,
"votes": 17
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Macrophages are responsible for increasing body temperature in fevers. They also act as antigen presenting cells and are involved in phagocytosis of cellular debris and pathogens.",
"id": "10007516",
"label": "a",
"name": "Macrophages",
"picture": null,
"votes": 81
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Mast cells are responsible for triggering the inflammatory response. They are present in tissues and in a similar way to basophils, release histamine during the allergic response. They also express IgE receptors on their cell surfaces.",
"id": "10007519",
"label": "d",
"name": "Mast cells",
"picture": null,
"votes": 104
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Basophils release histamine and trigger allergic reactions. They express igE receptors on their cell surface. They have a Bi-lobed nucleus.",
"id": "10007518",
"label": "c",
"name": "Basophils",
"picture": null,
"votes": 26
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
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"demo": null,
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"id": "4607",
"name": "Macrophages",
"status": null,
"topic": {
"__typename": "Topic",
"id": "158",
"name": "Immunology",
"typeId": 7
},
"topicId": 158,
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"question": "A 41-year-old male presents to the GP with a productive cough and shortness of breath. On examination, his temperature is 38.8 degrees.\n\nWhich of the following cell types are responsible for increasing body temperature?",
"sbaAnswer": [
"a"
],
"totalVotes": 295,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,343 | false | 6 | null | 6,495,113 | null | false | [] | null | 14,051 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the mechanism of action of warfarin, an oral anticoagulant used as first-line management of VTE for many years, before being surpassed by the use of direct oral anticoagulants (DOACs). Nowadays, warfarin use is indicated in patients with mechanical heart valves and as a second line after DOACs. This does not describe the mechanism of action of LMWH, which activates antithrombin 3.",
"id": "10007525",
"label": "e",
"name": "Inhibits epoxide reductase",
"picture": null,
"votes": 18
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This describes the mechanism of action of statins, not low molecular weight heparin. HMG-CoA reductase is the enzyme involved in hepatic cholesterol synthesis, which reduces the production of low-density lipoprotein (LDL) cholesterol In the blood. This does not describe the mechanism of action of LMWH, which activates antithrombin 3.",
"id": "10007522",
"label": "b",
"name": "Inhibit HMG-CoA reductase",
"picture": null,
"votes": 33
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This describes the mechanism of clopidogrel, an antiplatelet agent used in the management of cardiovascular disease. This does not describe the mechanism of action of LMWH, which activates antithrombin 3.",
"id": "10007524",
"label": "d",
"name": "Antagonist of ADP receptor",
"picture": null,
"votes": 27
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the mechanism of action of isoniazid, a drug given for tuberculosis. This does not describe the mechanism of action of LMWH, which activates antithrombin 3.",
"id": "10007523",
"label": "c",
"name": "Inhibits mycolic acid synthesis",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. LMWH activates antithrombin III, and then forms a complex that inhibits factor Xa. This brings about an anticoagulant effect. This means that LMWH can be monitored through anti-factor Xa, although routine monitoring is not usually required.",
"id": "10007521",
"label": "a",
"name": "Activates antithrombin 3",
"picture": null,
"votes": 196
}
],
"comments": [],
"concept": {
"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4608",
"name": "Low molecular weight heparin",
"status": null,
"topic": {
"__typename": "Topic",
"id": "203",
"name": "Pharmacology of Haemostasis and Thrombosis",
"typeId": 7
},
"topicId": 203,
"totalCards": null,
"typeId": null,
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},
"conceptId": 4608,
"conditions": [],
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"dislikes": 0,
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"question": "A 30-year-old pregnant woman attends the emergency department with left leg pain and swelling. An ultrasound doppler demonstrates a deep vein thrombosis. She is treated with low molecular weight heparin (LMWH).\n\nWhich of the following correctly describes the mechanism of action of LMWH?",
"sbaAnswer": [
"a"
],
"totalVotes": 279,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,344 | false | 7 | null | 6,495,113 | null | false | [] | null | 14,052 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Antibiotics like Metronidazole work by damaging DNA. Clindamycin does not work in this way but instead works by inhibiting protein synthesis.",
"id": "10007529",
"label": "d",
"name": "Damages DNA",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the mechanism of action of sulphonamides and trimethoprim. Clindamycin does not work in this way but instead works by inhibiting protein synthesis.",
"id": "10007528",
"label": "c",
"name": "Inhibits folic acid formation",
"picture": null,
"votes": 20
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Antibiotics like Rifampicin work by inhibiting the synthesis of RNA. Clindamycin does not work in this way but instead works by inhibiting protein synthesis.",
"id": "10007530",
"label": "e",
"name": "Inhibits RNA synthesis",
"picture": null,
"votes": 41
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "There are various classes of antibiotics that work by inhibiting cell wall formation. Some interrupt peptidoglycan cross-linking (penicillin and cephalosporins) and others inhibit peptidoglycan synthesis (glycopeptides like vancomycin). Clindamycin does not work in this way but instead works by inhibiting protein synthesis.",
"id": "10007527",
"label": "b",
"name": "Inhibits cell wall formation",
"picture": null,
"votes": 80
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. Clindamycin inhibits protein synthesis by acting on the ribosome. Other antibiotics that act in the same way include: macrolides, aminoglycosides and tetracycline.",
"id": "10007526",
"label": "a",
"name": "Inhibits protein synthesis",
"picture": null,
"votes": 131
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
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"typeId": 7
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"demo": null,
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"id": "3887",
"name": "Antibiotics",
"status": null,
"topic": {
"__typename": "Topic",
"id": "148",
"name": "Microbiology",
"typeId": 7
},
"topicId": 148,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
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"dislikes": 0,
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"question": "A 50-year-old male presents to the GP with a red, painful right shin that began a week ago. He reports feeling unwell with a high temperature for the past 3 days. The GP suspects cellulitis and the patient is treated with a course of clindamycin.\n\nWhich of the following correctly describes the mechanism of action of clindamycin?",
"sbaAnswer": [
"a"
],
"totalVotes": 277,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,345 | false | 8 | null | 6,495,113 | null | false | [] | null | 14,053 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. In zero-order reactions, the half-life can vary. In fact, the half-life will get longer as the concentration of the drug increases.",
"id": "10007534",
"label": "d",
"name": "The half life is always constant",
"picture": null,
"votes": 56
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Phenytoin works by pseudo-zero order reactions. This means that at high concentrations the elimination process is saturated, and processing appears similar to zero-order reactions in which the rate of the reaction is independent of the drug concentration. However, at lower concentrations, the process is not saturated and the reaction appears like first-order reactions. Here, the rate of the reaction is proportional to the concentration of the reactant.",
"id": "10007532",
"label": "b",
"name": "Phenytoin works by zero order reactions",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. Zero-order reactions have a rate of elimination that is independent of the drug concentration.",
"id": "10007531",
"label": "a",
"name": "The rate of degradation is independent of the plasma concentration",
"picture": null,
"votes": 147
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Zero-order reactions are rare. The most common order of elimination is first-order reactions, whereby the half-life is constant, and the rate of elimination increases with plasma concentration.",
"id": "10007535",
"label": "e",
"name": "It is the most common order of elimination",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. The rate of degradation does not rely on the concentration of the reactant in zero-order reactions.",
"id": "10007533",
"label": "c",
"name": "The rate of degradation is dependent on the concentration of reactant",
"picture": null,
"votes": 56
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
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"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4609",
"name": "Zero order kinetics",
"status": null,
"topic": {
"__typename": "Topic",
"id": "166",
"name": "General pharmacological concepts",
"typeId": 7
},
"topicId": 166,
"totalCards": null,
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"question": "A 75-year-old female attends the emergency department after accidentally taking too much of her regular medication. She is keen to know for how long the medication will remain in her bloodstream.\n\nWhich of the following statements is correct about zero order kinetics?",
"sbaAnswer": [
"a"
],
"totalVotes": 270,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,346 | false | 9 | null | 6,495,113 | null | false | [] | null | 14,054 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "IgA is the most predominant immunoglobulin found in breast milk. It can also be found in secretions of the digestive, respiratory and urogenital systems. The other role of IgA is to provided protection on cell mucus membranes. It does not pass into the foetal circulation.",
"id": "10007537",
"label": "b",
"name": "IgA",
"picture": null,
"votes": 32
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "IgE is associated with Type 1 Hypersensitivity reactions. It is synthesized by plasma cells and provides immunity to parasites such as helminths. It is not typically seen in foetal circulation.",
"id": "10007538",
"label": "c",
"name": "IgE",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This immunoglobin is the only type that is able to pass into the foetal circulation. IgG is also involved in the phagocytosis of bacteria and viruses, and is the most abundant type of immunoglobulin found in the blood serum.",
"id": "10007536",
"label": "a",
"name": "IgG",
"picture": null,
"votes": 192
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "IgG is the immunoglobulin involved in activation of B cells. It cannot cross the placenta.",
"id": "10007540",
"label": "e",
"name": "IgD",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "IgM cannot pass into fetal circulation. However, it does fix to complement in a similar way to IgG. The defining feature of IgM is that it is the first immunoglobulin to be secreted in response to infection. It is secreted as a pentamer.",
"id": "10007539",
"label": "d",
"name": "IgM",
"picture": null,
"votes": 35
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3854",
"name": "Antibodies",
"status": null,
"topic": {
"__typename": "Topic",
"id": "158",
"name": "Immunology",
"typeId": 7
},
"topicId": 158,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
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},
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"dislikes": 0,
"explanation": null,
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"likes": 0,
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"question": "A 29-year-old pregnant female attends a routine 28-week antenatal appointment. She is keen to know more about the foetal immune system. The midwife explains that there are five different types of immunoglobulin found in the body, but only one can cross the placenta to reach the foetal circulation.\n\nWhich of the following immunoglobulins can cross the placenta?",
"sbaAnswer": [
"a"
],
"totalVotes": 269,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,347 | false | 10 | null | 6,495,113 | null | false | [] | null | 14,055 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Group O blood can be universally donated, so is the most appropriate choice for a patient with an unknown blood group. Group O blood does not contain any A or B antigens on its surface, and therefore no circulating antibodies, which prevents an immune reaction from occurring.",
"id": "10007541",
"label": "a",
"name": "Group O",
"picture": null,
"votes": 253
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "We cannot give this patient group B blood as we do not know this patient’s blood group. The only blood group that he can receive is group O blood. This is because group O blood does not contain any A or B antigens or antibodies, and therefore whatever blood group this patent happens to be, we know there will be no transfusion reaction. By contrast, Group B blood has B antigens on the red blood cell surface and anti-A antibodies in the plasma.",
"id": "10007544",
"label": "d",
"name": "Group B",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "We haven’t been told this patient’s blood group. Therefore, the only blood group that can be donated to them is group O blood. Group O blood does not contain any A or B antigens or antibodies, so will not react with any blood groups. By contrast, Group A blood has A antigens on the red blood cell surface and anti-B antibodies in the plasma.",
"id": "10007542",
"label": "b",
"name": "Group A",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "We cannot transfuse group AB blood as we do not know this patient’s blood group. Therefore, the only blood group we are able to donate at this point will be group O blood.",
"id": "10007543",
"label": "c",
"name": "Group AB",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "We can only donate group O blood to this patient. This is because group O blood does not contain any A or B antigens and therefore it is the only blood group that can be universally donated. If this patient had group B blood and we gave them group A blood, their anti- A antibodies will attack the group A cells.",
"id": "10007545",
"label": "e",
"name": "Group A and O",
"picture": null,
"votes": 3
}
],
"comments": [],
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},
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"demo": null,
"entitlement": null,
"id": "3796",
"name": "Blood group compatibility",
"status": null,
"topic": {
"__typename": "Topic",
"id": "157",
"name": "Haematology",
"typeId": 7
},
"topicId": 157,
"totalCards": null,
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"question": "A 21-year-old male requires an emergency blood transfusion after arriving in the emergency department following a road traffic collision. He has never received a blood transfusion before, and his blood group is unknown.\n\nWhich of the following blood types can he receive?",
"sbaAnswer": [
"a"
],
"totalVotes": 264,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,348 | false | 11 | null | 6,495,113 | null | false | [] | null | 14,056 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A deficiency in clotting factor IX would mean the patient has haemophilia B, not haemophilia A.",
"id": "10007548",
"label": "c",
"name": "IX",
"picture": null,
"votes": 12
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Factor X deficiency would mean the patient had a rare genetic bleeding disorder. Haemophilia A is a deficiency in factor VIII.",
"id": "10007549",
"label": "d",
"name": "X",
"picture": null,
"votes": 18
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Haemophilia A is deficiency in factor VIII rather than factor XI.",
"id": "10007550",
"label": "e",
"name": "XI",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Factor 7 deficiency would mean the patient has a rare genetic bleeding disorder, known as Alexander’s disease, not haemophilia A. Deficiency in factor VII would cause nosebleeds, easy bruising, prolonged bleeding following physical injury or surgery. It would rarely cause bleeding into joint spaces.",
"id": "10007547",
"label": "b",
"name": "VII",
"picture": null,
"votes": 32
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Haemophilia A is caused by a deficiency of clotting factor VIII, an important part of the intrinsic component of the coagulation cascade. Haemophilia A typically presents with severe bleeding into soft tissues, muscles, and joints, and is diagnosed with a factor VIII assay.",
"id": "10007546",
"label": "a",
"name": "VIII",
"picture": null,
"votes": 202
}
],
"comments": [],
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"__typename": "Concept",
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},
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"demo": null,
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"id": "3925",
"name": "haemophilia",
"status": null,
"topic": {
"__typename": "Topic",
"id": "157",
"name": "Haematology",
"typeId": 7
},
"topicId": 157,
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"question": "An 8-year-old female attends her GP surgery with recurrent haemarthrosis. She undergoes multiple blood tests and is diagnosed with haemophilia A.\n\nWhich of the following clotting factors is the patient deficient in?",
"sbaAnswer": [
"a"
],
"totalVotes": 266,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,349 | false | 12 | null | 6,495,113 | null | false | [] | null | 14,057 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This does not fit with the clinical picture described. Stress fractures often occur after low-grade repetitive stress to a joint. Anaemia and hypercalcaemia are not typically seen.",
"id": "10007553",
"label": "c",
"name": "Stress fracture",
"picture": null,
"votes": 23
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Sarcoidosis would present differently from the clinical picture described. Acute sarcoidosis presents with fever, joint pains, erythema nodosum, and bilateral hilar lymphadenopathy. Chronic sarcoidosis is characterised by pulmonary symptoms such as a dry cough, dyspnoea, reduced exercise tolerance, and crepitations on examination.",
"id": "10007554",
"label": "d",
"name": "Sarcoidosis",
"picture": null,
"votes": 11
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Osteosarcoma is a type of bone cancer typically found in children or young adults. X-ray would commonly find a 'sunburst' pattern.",
"id": "10007552",
"label": "b",
"name": "Osteosarcoma",
"picture": null,
"votes": 54
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is a typical presentation of multiple myeloma. The clinical features can be remembered with the mnemonic CRABI: hypercalcemia, renal impairment, anaemia, bone pathology, and infections.",
"id": "10007551",
"label": "a",
"name": "Multiple myeloma",
"picture": null,
"votes": 152
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Acute myeloid leukaemia (AML) can present with some similar features to multiple myeloma, for example, symptoms of bone marrow failure like anaemia and frequent infections. However, AML commonly involves examination findings such as hepatomegaly, splenomegaly or gum hypertrophy. By contrast, hypercalcaemia and back pain point towards a diagnosis of multiple myeloma.",
"id": "10007555",
"label": "e",
"name": "Acute myeloid leukaemia",
"picture": null,
"votes": 23
}
],
"comments": [],
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"__typename": "Concept",
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"explanation": null,
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"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3923",
"name": "myeloma",
"status": null,
"topic": {
"__typename": "Topic",
"id": "157",
"name": "Haematology",
"typeId": 7
},
"topicId": 157,
"totalCards": null,
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},
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"question": "An 81-year-old female presents to the emergency department with severe back pain. On further investigation, you discover she has normocytic anaemia, raised serum creatinine, and a high calcium level. X-ray shows a fracture of the left femur.\n\nWhich of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 263,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,350 | false | 13 | null | 6,495,113 | null | false | [] | null | 14,058 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This presentation is most likely to be a pulmonary embolism (PE). ST depression is not an ECG finding typically seen in PE. It is indicative of cardiac ischaemia.",
"id": "10007560",
"label": "e",
"name": "ST depression",
"picture": null,
"votes": 20
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The presence of U waves on ECG is characteristic of hypokalaemia. U waves would be seen as a deflection immediately following the T wave. Hypokalaemia may present with symptoms such as muscle cramps, dizziness, polyuria, polydipsia, and in severe cases, arrhythmias. This history gives no indication of hypokalaemia. This presentation is most likely to be a pulmonary embolism (PE).",
"id": "10007558",
"label": "c",
"name": "U waves",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a relatively uncommon ECG finding in PE, only presenting in around 20% of patients. An ECG finding of sinus tachycardia is a more likely finding.",
"id": "10007557",
"label": "b",
"name": "S1Q3T3",
"picture": null,
"votes": 62
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This presentation is most likely to be a pulmonary embolism (PE). T wave inversion is not an ECG finding typically seen in PE. It is indicative of cardiac ischaemia, past or present.",
"id": "10007559",
"label": "d",
"name": "T wave inversion",
"picture": null,
"votes": 23
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This presentation is most likely to be a pulmonary embolism (PE). Sudden onset shortness of breath, pleuritic chest pain and haemoptysis is the typical triad for a PE in exam questions. The most common finding on ECG in a PE is sinus tachycardia. The classic S1Q3T3 (deep S waves in lead I, pathological Q waves in lead III, and inverted T waves in lead III) is uncommon, presenting in around 20% of patients.",
"id": "10007556",
"label": "a",
"name": "Sinus tachycardia",
"picture": null,
"votes": 149
}
],
"comments": [],
"concept": {
"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
"files": null,
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"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3724",
"name": "Pulmonary Embolism",
"status": null,
"topic": {
"__typename": "Topic",
"id": "132",
"name": "Respiratory",
"typeId": 7
},
"topicId": 132,
"totalCards": null,
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},
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"conditions": [],
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"question": "A 28-year-old man presents to the emergency department with pleuritic chest pain and shortness of breath that began 6 hours ago. On further questioning, he also reports bringing up small flecks of bright red blood when coughing. He has recently begun a course of chemotherapy for renal carcinoma.\n\nOn examination, he has a heart rate of 107 and respiratory rate of 20. His oxygen saturations are 88%.\n\nWhich of the following ECG findings is the most likely to be seen?",
"sbaAnswer": [
"a"
],
"totalVotes": 263,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,351 | false | 14 | null | 6,495,113 | null | false | [] | null | 14,059 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "It is important to first trial a long-acting B2-agonist like salmeterol. A high-dose steroid may be considered later in the management plan if salmeterol is not considered sufficient.",
"id": "10007565",
"label": "e",
"name": "High dose steroid",
"picture": null,
"votes": 36
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient requires additional treatment for her chronic asthma. She is already taking a short-acting inhaled B2-agonist (salbutamol) and a low-dose inhaled corticosteroid (beclomethasone dipropionate). As per the NICE guidelines, the next step in treatment is to add a leukotriene receptor antagonist first, and then trial a long-acting B2 agonist such as Salmeterol.",
"id": "10007561",
"label": "a",
"name": "Salmeterol",
"picture": null,
"votes": 89
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The patient is taking a short-acting inhaled B2 agonist as well as a low-dose inhaled corticosteroid. The next step would be to add a long-acting B2 agonist like salmeterol alongside the low-dose inhaled corticosteroid.",
"id": "10007564",
"label": "d",
"name": "Stop beclomethasone dipropionate and begin salmeterol",
"picture": null,
"votes": 64
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Adding an oral leukotriene receptor antagonist would be appropriate at this stage, as per the NICE guidelines. ",
"id": "10007563",
"label": "c",
"name": "Montelukast",
"picture": null,
"votes": 59
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient is apyrexial and her symptom exacerbation is chronic in nature, making an infective picture less likely. Poorly controlled asthma is the most likely underlying diagnosis. Therefore the best treatment option would be to manage this patient with salmeterol, a long-acting B2-agonist.",
"id": "10007562",
"label": "b",
"name": "Oral antibiotics",
"picture": null,
"votes": 7
}
],
"comments": [],
"concept": {
"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4480",
"name": "Asthma",
"status": null,
"topic": {
"__typename": "Topic",
"id": "162",
"name": "General practice",
"typeId": 5
},
"topicId": 162,
"totalCards": null,
"typeId": null,
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},
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"conditions": [],
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"dislikes": 1,
"explanation": null,
"highlights": [],
"id": "14059",
"isLikedByMe": 0,
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"likes": 2,
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"question": "A 19-year-old female attends her asthma review complaining of worsening shortness of breath and chest tightness for the past 3 months, as well as a dry cough that is worse at night. She has a beclomethasone dipropionate inhaler which she takes as instructed, as well as a salbutamol inhaler to use as required. She has been needing to use her salbutamol inhaler almost every day to get on top of her symptoms.\n\nAll observations are normal: she is apyrexial and feeling otherwise well. She has no other medical conditions.\n\nWhich of the following is the most appropriate management?",
"sbaAnswer": [
"c"
],
"totalVotes": 255,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,352 | false | 15 | null | 6,495,113 | null | false | [] | null | 14,060 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This most commonly occurs in patients who have an unsafe swallow, including those with myasthenia gravis, stroke, bulbar palsy, alcoholism, or achalasia. This type of pneumonia most commonly affects the right lung, as the right bronchus is wider than the left, making it more likely to facilitate the aspirate.",
"id": "10007567",
"label": "b",
"name": "Aspiration pneumonia",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Klebsiella pneumonia usually affected patients with weakened immune systems, like the elderly, alcoholics and patients with diabetes. It mostly affects the upper lobes and produces ‘’red currant’’ sputum.",
"id": "10007569",
"label": "d",
"name": "Klebsiella pneumoniae",
"picture": null,
"votes": 16
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is a typical presentation of pneumocystis pneumonia: exertional dyspnoea, dry cough and fever in a HIV positive patient. In patients who are HIV positive, the risk of PCP increases when their CD4 count is under 200 cells/uL.",
"id": "10007566",
"label": "a",
"name": "Pneumocystis Jirovecii",
"picture": null,
"votes": 175
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Mycoplasma pneumonia is typically seen in younger patients with flu-like symptoms. It can also cause autoimmune haemolytic anaemia.",
"id": "10007568",
"label": "c",
"name": "Mycoplasma pneumoniae",
"picture": null,
"votes": 44
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Legionella pneumonia presents with fever and muscle pain, followed by shortness of breath and a dry cough. In exams, look out for hyponatremia and deranged liver function tests.",
"id": "10007570",
"label": "e",
"name": "Legionella Pneumophila",
"picture": null,
"votes": 19
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
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"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4610",
"name": "Pneumocystis Pneumonia",
"status": null,
"topic": {
"__typename": "Topic",
"id": "132",
"name": "Respiratory",
"typeId": 7
},
"topicId": 132,
"totalCards": null,
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},
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"explanation": null,
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"question": "A 50-year-old male presents to the emergency department with a high temperature and non-productive cough that began 2 weeks ago. His past medical history includes type 2 diabetes mellitus and HIV. His last CD4 count was 177 cells/uL.\n\nWhich of the following is the most likely organism causing his lower respiratory tract infection?",
"sbaAnswer": [
"a"
],
"totalVotes": 258,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,353 | false | 16 | null | 6,495,113 | null | false | [] | null | 14,061 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Pneumonia causes type 1 respiratory failure, which occurs due to a ventilation-perfusion (V/Q) mismatch. This means that the volume of air that is passing into and out of the lungs is much smaller than the volume of blood perfusing the lungs, resulting in hypoxia but a normal serum carbon dioxide level. This patient demonstrates type 2 respiratory failure, with hypercapnia as well as hypoxia, making this option incorrect.",
"id": "10007572",
"label": "b",
"name": "Pneumonia",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a cause of type 1 respiratory failure. The bronchoconstriction present in asthma causes areas of the lungs that have poor ventilation with oxygen but are well perfused by blood. This results in hypoxia, but a normal carbon dioxide level. This patient demonstrates type 2 respiratory failure, with hypercapnia as well as hypoxia, making this option incorrect.",
"id": "10007575",
"label": "e",
"name": "Asthma",
"picture": null,
"votes": 15
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a cause of type 1 respiratory failure. A pulmonary embolism causes a ventilation-perfusion mismatch, meaning the volume of air passing in and out of the lungs is smaller than the volume of blood perfusing the lungs. This results in hypoxia, but a normal carbon dioxide level. This patient demonstrates type 2 respiratory failure, with hypercapnia as well as hypoxia, making this option incorrect.",
"id": "10007574",
"label": "d",
"name": "Pulmonary Embolism",
"picture": null,
"votes": 12
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a cause of type 1 respiratory failure, not type 2.",
"id": "10007573",
"label": "c",
"name": "Pneumothorax",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "An opiate overdose causes depression of the respiratory centre, and therefore results in type 2 respiratory failure (hypoxia plus hypercapnia). Type 2 respiratory failure occurs due to a reduction in alveolar ventilation, meaning that the lungs fail both to effectively oxygenate the blood and to remove carbon dioxide. Other causes of type 2 respiratory failure include idiopathic pulmonary fibrosis, COPD, Guillain-Barre syndrome, and motor neuron disease.",
"id": "10007571",
"label": "a",
"name": "Opiate overdose",
"picture": null,
"votes": 214
}
],
"comments": [],
"concept": {
"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4546",
"name": "Respiratory failure",
"status": null,
"topic": {
"__typename": "Topic",
"id": "132",
"name": "Respiratory",
"typeId": 7
},
"topicId": 132,
"totalCards": null,
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},
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"dislikes": 0,
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"question": "A 50-year-old male is bought into the emergency department after being found unresponsive at home. He opens his eyes to pain but makes only incomprehensible groans when asked questions.\n\nHe has a past medical history of depression and hay fever, and takes regular sertraline.\n\nAn arterial blood gas is performed which shows the following:\n\nPaO2 =9\n\nPaCO2 = 7\n\nWhich of the following is the most likely cause of this patient’s presentation?",
"sbaAnswer": [
"a"
],
"totalVotes": 251,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,354 | false | 17 | null | 6,495,113 | null | false | [] | null | 14,062 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This would cause a decrease in the BNP levels. Other factors that cause BNP levels to decrease include: diuretics, ACE inhibitors, beta blockers, angiotensin receptor blockers and aldosterone antagonists.",
"id": "10007576",
"label": "a",
"name": "Obesity",
"picture": null,
"votes": 62
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Diabetes causes BNP levels to increase rather than decrease.",
"id": "10007579",
"label": "d",
"name": "Type 2 diabetes",
"picture": null,
"votes": 32
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This causes an increase in BNP level.",
"id": "10007580",
"label": "e",
"name": "COPD",
"picture": null,
"votes": 31
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "An age over 70 would cause BNP levels to increase. Other factors that cause an increase in BNP levels include: tachycardia, hypoxemia, sepsis, COPD and liver cirrhosis.",
"id": "10007577",
"label": "b",
"name": "Age over 70",
"picture": null,
"votes": 48
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This would cause an increase in BNP levels.",
"id": "10007578",
"label": "c",
"name": "Left ventricular hypertrophy",
"picture": null,
"votes": 76
}
],
"comments": [],
"concept": {
"__typename": "Concept",
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},
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"id": "3798",
"name": "Heart Failure",
"status": null,
"topic": {
"__typename": "Topic",
"id": "134",
"name": "Cardiology",
"typeId": 7
},
"topicId": 134,
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"question": "A 77-year-old male is admitted to the cardiac ward with increasing shortness of breath over the last 2 months. You suspect a diagnosis of heart failure and conduct a N-terminal pro-B-type natriuretic peptide (BNP) blood test.\n\nWhich of the following factors would cause a decrease in this patient’s BNP level?",
"sbaAnswer": [
"a"
],
"totalVotes": 249,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,355 | false | 18 | null | 6,495,113 | null | false | [] | null | 14,063 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This organism is associated with colorectal cancer. The patient in this question does not have colorectal cancer, therefore colonization with streptococcus bovis is unlikely. Staphylococcus aureus is the most common cause of infective endocarditis overall and is the most likely causative organism in this case.",
"id": "10007582",
"label": "b",
"name": "Streptococcus Bovis",
"picture": null,
"votes": 11
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the most common cause of endocarditis in patients following prosthetic valve surgery. However, the risk of this is only within the first 2 months after surgery. We are told our patient had prosthetic valve surgery 4 months ago; therefore his chance of colonization with staph epidermis has returned to normal. Staphylococcus aureus is the most common cause of infective endocarditis overall and is the most likely causative organism in this case.",
"id": "10007584",
"label": "d",
"name": "Staphlococcus epidermis",
"picture": null,
"votes": 43
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is an uncommon cause of infective endocarditis and therefore is not the most likely causative organism of this patient’s infective endocarditis. Staphylococcus aureus is the most common cause of infective endocarditis overall and is the most likely causative organism in this case.",
"id": "10007585",
"label": "e",
"name": "Coxiella burnetii",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This organism is found in dental plaque and is a common cause of endocarditis in patients with poor dental hygiene or following a dental procedure. It is also the most common cause of endocarditis in developing countries. However, staphylococcus aureus is the most common cause of infective endocarditis overall and is the most likely causative organism in this case.",
"id": "10007583",
"label": "c",
"name": "Streptococcus viridans",
"picture": null,
"votes": 25
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient has the typical findings of infective endocarditis: fevers (most common), weight loss, pleuritic chest pain, night sweats, and lethargy. During the first 2 months following prosthetic valve surgery, the patient is at risk of infective endocarditis caused by staphylococcus epidermis. However, this patient had surgery 4 months ago, and the risk of staphylococcus epidermis colonization has now returned to normal. The most common causative organism of infective endocarditis overall is staphylococcus aureus, and therefore this is the most likely finding in this case.",
"id": "10007581",
"label": "a",
"name": "Staphylococcus aureus",
"picture": null,
"votes": 170
}
],
"comments": [],
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},
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"demo": null,
"entitlement": null,
"id": "3710",
"name": "Infective Endocarditis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "134",
"name": "Cardiology",
"typeId": 7
},
"topicId": 134,
"totalCards": null,
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"question": "A 70-year-old male presents to the emergency department with a 1-month history of fever, weight loss and chest pain that is worse on inspiration. He tells you he has been feeling generally worn down with muscle and joint pains and he also noticed some night sweats. You notice macules on the patient’s palms and soles consistent with Janeway lesions and splinter haemorrhages on the patient’s nails.\n\nHe underwent a prosthetic valve replacement 4 months ago, but is otherwise fit and well.\n\nGiven the likely diagnosis, which of the following is the most likely causative organism?",
"sbaAnswer": [
"a"
],
"totalVotes": 249,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,356 | false | 19 | null | 6,495,113 | null | false | [] | null | 14,064 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A beta blocker is not the correct treatment for Mobitz type II heart block.",
"id": "10007590",
"label": "e",
"name": "Bisoprolol",
"picture": null,
"votes": 28
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This may be an option if the patient was presenting with a second STEMI within 12 hours of symptoms. However, this ECG shows a type of second degree heart block called Mobitz type II. Therefore, the most appropriate management would be to insert a pacemaker.",
"id": "10007589",
"label": "d",
"name": "Percutaneous Coronary Intervention",
"picture": null,
"votes": 18
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This would be an appropriate treatment if the patient was presenting with a Type A aortic dissection. However, this patient has no clinical features of this, and their ECG shows a type of heart block known as Mobitz type II.",
"id": "10007587",
"label": "b",
"name": "Aortic graft",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This may be an option if the ECG was showing first-degree heart block. First-degree heart block can be identified on an ECG by finding a PR interval over 200ms. However, this patient demonstrates Mobitz type II heart block, the treatment of which is with a permanent pacemaker as these patients are at risk of going into complete heart block",
"id": "10007588",
"label": "c",
"name": "No treatment needed",
"picture": null,
"votes": 24
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient’s ECG describes a type of heart block called Mobitz type II. This is a type of second degree AV block where there are intermittent non-conducted P waves but the PR interval remains constant. It is commonly caused by a conduction system failure at the His-Purkinje system. The management of Mobitz type II is with a permanent pacemaker as these patients are at risk of going into complete heart block.",
"id": "10007586",
"label": "a",
"name": "Pacemaker",
"picture": null,
"votes": 176
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3699",
"name": "Heart Block",
"status": null,
"topic": {
"__typename": "Topic",
"id": "134",
"name": "Cardiology",
"typeId": 7
},
"topicId": 134,
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},
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"question": "A 77-year-old female is reviewed in cardiology clinic after suffering an anterior myocardial infarction two months ago. Her ECG shows intermittent non-conducted P waves with constant PR intervals.\n\nWhich of the following is the most appropriate management?",
"sbaAnswer": [
"a"
],
"totalVotes": 246,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,357 | false | 20 | null | 6,495,113 | null | false | [] | null | 14,065 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The ECG changes shown in the question correspond to the left anterior descending artery, not the right marginal artery.",
"id": "10007595",
"label": "e",
"name": "Right marginal artery",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "An occlusion in the left circumflex artery would cause changes in leads I and aVL.",
"id": "10007592",
"label": "b",
"name": "Left Circumflex",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The right coronary artery corresponds to leads II, III and aVF.",
"id": "10007593",
"label": "c",
"name": "Right coronary artery",
"picture": null,
"votes": 20
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The proximal left anterior descending artery would cause changed in leads V1-6 as well as leads I and AVL.",
"id": "10007594",
"label": "d",
"name": "Proximal left anterior descending",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The ECG changes shown in this question (V1-V4) correspond to the left anterior descending artery, therefore making this the correct answer.",
"id": "10007591",
"label": "a",
"name": "Left Anterior Descending",
"picture": null,
"votes": 206
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"id": "2693",
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"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3713",
"name": "Myocardial infarction and Acute Coronary Syndrome (ACS)",
"status": null,
"topic": {
"__typename": "Topic",
"id": "134",
"name": "Cardiology",
"typeId": 7
},
"topicId": 134,
"totalCards": null,
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"userNote": null,
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},
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"question": "A 50-year-old female presents to the emergency department with central crushing chest pain that began one hour ago. An ECG shows ST elevation in leads V1-4.\n\nIn which of the following coronary arteries is the most likely site of occlusion?",
"sbaAnswer": [
"a"
],
"totalVotes": 249,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,358 | false | 21 | null | 6,495,113 | null | false | [] | null | 14,066 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient is asymptomatic and therefore would require a second HbA1c result above 48mmol/L in order to diagnose type 2 diabetes mellitus. Therefore, it would not be appropriate to begin insulin.",
"id": "10007597",
"label": "b",
"name": "Commence insulin replacement regime",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient is asymptomatic but does have a HbA1c of above 48mmol/L. In order to diagnose Type 2 diabetes mellitus, the patient would need a second Hba1c above 48mmol/L measured on a different day. It would not be diagnostic to have a second HbA1c done immediately.",
"id": "10007600",
"label": "e",
"name": "Repeat HbA1c immediately",
"picture": null,
"votes": 28
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient is asymptomatic and therefore would require a second HbA1c result above 48mmol/L in order to diagnose type 2 diabetes mellitus. Therefore, it would not be appropriate to begin metformin at this stage.",
"id": "10007598",
"label": "c",
"name": "Commence metformin",
"picture": null,
"votes": 16
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient has an HbA1C of 52mmol/L. The diagnostic threshold of diabetes is an HbA1c greater than or equal to 48mmol/L. However, this patient is asymptomatic. In patients with no symptoms, the test must be repeated on a different day to confirm the diagnosis.",
"id": "10007596",
"label": "a",
"name": "Repeat HbA1c in 2 weeks",
"picture": null,
"votes": 188
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Type 2 diabetes mellitus cannot be diagnosed in this patient at this stage. This is because the patient is asymptomatic and has only had 1 HbA1c above 48mmol/L. Therefore, the test must be repeated on a different day to confirm the diagnosis.",
"id": "10007599",
"label": "d",
"name": "Diagnose Type 2 Diabetes Mellitus",
"picture": null,
"votes": 17
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3761",
"name": "Type 2 Diabetes Mellitus",
"status": null,
"topic": {
"__typename": "Topic",
"id": "133",
"name": "Endocrinology",
"typeId": 5
},
"topicId": 133,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3761,
"conditions": [],
"difficulty": 1,
"dislikes": 1,
"explanation": null,
"highlights": [],
"id": "14066",
"isLikedByMe": 0,
"learningPoint": null,
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"multiAnswer": null,
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"question": "A 40-year-old female is discovered to have an HbA1c of 52mmol/L (normal range 20-42 mmol/L) on a routine blood test. She denies any symptoms of polyuria or polydipsia.\n\n\nWhich of the following is the most appropriate next step?",
"sbaAnswer": [
"a"
],
"totalVotes": 251,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,359 | false | 22 | null | 6,495,113 | null | false | [] | null | 14,067 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Hyperthyroidism would present with weight loss rather than gain, as well as symptoms like sweating, anxiety, palpitations, sensitivity to heat, and diarrhoea.",
"id": "10007604",
"label": "d",
"name": "Hyperthyroidism",
"picture": null,
"votes": 19
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is a typical presentation of hypothyroidism. The patient describes general symptoms of weight gain and lethargy, and is experiencing anhydrosis and hair loss. Hypothyroidism also impacts the gastrointestinal system causing constipation. It can also cause menorrhagia in some patients, although this is not specifically mentioned.",
"id": "10007601",
"label": "a",
"name": "Hypothyroidism",
"picture": null,
"votes": 225
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A presentation of Addison's disease can present with symptoms such as lethargy and weakness similar to those seen in this patient. However, you would expect Addison’s to cause weight loss, rather than gain and would also expect symptoms such as nausea and vomiting, hyperpigmentation of the skin, and vitiligo. Addison's is also typically associated with hyponatremia and hyperkalaemia.",
"id": "10007602",
"label": "b",
"name": "Addison's Disease",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Type 1 diabetes mellitus typically causes weight loss rather than gain, as well as symptoms such as polyuria and polydipsia. A first presentation of type 1 diabetes can present as an episode of diabetic ketoacidosis with abdominal pain, vomiting, and reduced consciousness level.",
"id": "10007603",
"label": "c",
"name": "Type 1 Diabetes Mellites",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Iron deficiency anaemia would present with a different clinical picture. Symptoms include lethargy, weakness, jaundice, heavy periods, and a change in bowel habits. It is not typically associated with weight gain. Hypothyroidism is therefore a more likely diagnosis.",
"id": "10007605",
"label": "e",
"name": "Iron Deficiency Anaemia",
"picture": null,
"votes": 4
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3765",
"name": "Hypothyroidism",
"status": null,
"topic": {
"__typename": "Topic",
"id": "133",
"name": "Endocrinology",
"typeId": 5
},
"topicId": 133,
"totalCards": null,
"typeId": null,
"userChapter": null,
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"explanation": null,
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"question": "A 19-year-old female attends the GP surgery with reports of extreme tiredness for the past four months. She is also troubled by hair loss and dry skin, and has noticed that her clothes are becoming too tight for her. On further questioning, you also find out she is more constipated than usual, despite no change to her diet.\n\nWhich of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 252,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,360 | false | 23 | null | 6,495,113 | null | false | [] | null | 14,068 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Central obesity, proximal weakness, depression and abdominal striae are typical of Cushing’s syndrome. The diagnostic investigation for Cushing’s syndrome is a low dose dexamethasone suppression test.\n\nBy contrast, 24-hour plasma metanephrines would be a diagnostic investigation if you suspect pheochromocytoma. The classic presentation of pheochromocytoma includes symptoms of episodic hypertension, anxiety, palpations, headaches and signs like tremor and hypertensive retinopathy.",
"id": "10007609",
"label": "d",
"name": "24-hour plasma metanephrines",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient presents with the key symptoms of Cushing’s syndrome: proximal myopathy, striae, obesity, and depression. It can also manifest as osteoporosis, a 'moon' shaped face, diabetes mellitus, hypokalaemia and hypertension. The diagnostic investigation for Cushing’s syndrome is a low dose dexamethasone suppression test.",
"id": "10007606",
"label": "a",
"name": "Dexamethasone suppression test",
"picture": null,
"votes": 172
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Central obesity, proximal weakness, depression and abdominal striae are typical of Cushing’s syndrome. A fluid deprivation test can be performed to diagnose diabetes insipidus, but would not be diagnostic in this case. The diagnostic investigation for Cushing’s syndrome is a low dose dexamethasone suppression test.\n\nDiabetes insipidus is characterized by patients producing large volumes of dilute urine, nocturia and excessive thirst. Before a fluid deprivation test, some baseline investigations involve renal function tests, blood glucose, urine dip and serum and urine osmolality tests.",
"id": "10007608",
"label": "c",
"name": "Fluid deprivation test",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Central obesity, proximal weakness, depression and abdominal striae are typical of Cushing’s syndrome. HbA1c is a useful diagnostic test for diabetes mellitus, but would not be diagnostic in this case. The diagnostic investigation for Cushing’s syndrome is a low dose dexamethasone suppression test.",
"id": "10007607",
"label": "b",
"name": "HbA1c",
"picture": null,
"votes": 18
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Central obesity, proximal weakness, depression and abdominal striae are typical of Cushing’s syndrome. The diagnostic investigation for Cushing’s syndrome is a low dose dexamethasone suppression test.\n\nBy contrast, a short synacthen test would confirm the diagnosis of Adrenal sufficiency, not Cushing’s disease. Adrenal insufficiency would present with symptoms like hypotension, fatigue and weakness, gastrointestinal symptoms, syncope and skin pigmentation. Blood tests would also show low sodium and high potassium.",
"id": "10007610",
"label": "e",
"name": "Short synacthen test",
"picture": null,
"votes": 43
}
],
"comments": [],
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"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3764",
"name": "Cushing's syndrome",
"status": null,
"topic": {
"__typename": "Topic",
"id": "133",
"name": "Endocrinology",
"typeId": 5
},
"topicId": 133,
"totalCards": null,
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"difficulty": 1,
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"highlights": [],
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"question": "A 25-year-old male attends the GP surgery after noticing a large amount of weight gain, particularly around his abdomen. He has also felt low in mood recently.\n\nOn examination, you observe abdominal striae and weakness in all four of his proximal limbs.\n\nWhich of the following is the next best investigation?",
"sbaAnswer": [
"a"
],
"totalVotes": 249,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,361 | false | 24 | null | 6,495,113 | null | false | [] | null | 14,069 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a disorder of iron metabolism where excessive iron accumulates in the body and is deposited in a number of sites including the liver, heart, joints, pancreas and skin. You would expect haemochromatosis to show deranged LFTs as well as a raised serum ferritin and raised transferring saturation.",
"id": "10007613",
"label": "c",
"name": "Haemochromatosis",
"picture": null,
"votes": 16
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "You would expect pancreatitis to present with symptoms like epigastric pain radiating to the back, pain relived by sitting forward and nausea and vomiting. Bloods may show leukocytosis and an extremely high amylase level.",
"id": "10007614",
"label": "d",
"name": "Acute Pancreatitis",
"picture": null,
"votes": 14
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "You would expect Wilson's disease to show low serum ceruloplasmin and copper levels. It would not account for the high ALT.",
"id": "10007615",
"label": "e",
"name": "Wilson’s disease",
"picture": null,
"votes": 24
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "You would expect Gilbert’s syndrome to cause a mildly raised bilirubin but otherwise normal blood results. It would not account for the raised ALP. Gilbert’s can cause a mild intermittent jaundice in relation to stress, infection, fasting, or exercise.",
"id": "10007612",
"label": "b",
"name": "Gilbert’s syndrome",
"picture": null,
"votes": 30
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "An isolated raised ALP is indicative of alpha-1 antitrypsin deficiency. This is an inherited condition that affects the lungs (causing emphysema) and the liver (causing cirrhosis and hepatocellular carcinoma).",
"id": "10007611",
"label": "a",
"name": "Alpha-1 Antitrypsin deficiency",
"picture": null,
"votes": 163
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
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"id": "2693",
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"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4593",
"name": "Alpha-1 Antitrypsin Deficiency",
"status": null,
"topic": {
"__typename": "Topic",
"id": "136",
"name": "Gastroenterology",
"typeId": 7
},
"topicId": 136,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4593,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "14069",
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"question": "A 46-year-old male attends his GP surgery with concerns that he is becoming more short of breath on exertion. He undergoes blood tests, which demonstrate a raised ALT at 68IU/L (normal range 10-50 IU/L). Bilirubin, ALP and albumin are all within the normal range.\n\n\nHe does not drink alcohol and his BMI is 24. His father has emphysema.\n\n\nWhich of the following is the most likely reason for this liver abnormality?",
"sbaAnswer": [
"a"
],
"totalVotes": 247,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,362 | false | 25 | null | 6,495,113 | null | false | [] | null | 14,070 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient is experiencing refeeding syndrome. It can occur in any patient who is malnourished and subsequently resumes feeding, however alcohol excess is a particular risk factor. Refeeding syndrome causes a fall in magnesium levels. It would also cause phosphate and potassium levels to be low, as well as hyperglycaemia.",
"id": "10007616",
"label": "a",
"name": "Low magnesium",
"picture": null,
"votes": 95
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient is experiencing refeeding syndrome. It can occur in any patient who is malnourished and subsequently resumes feeding, however alcohol excess is a particular risk factor. Refeeding syndrome would cause low B1 levels, not high.",
"id": "10007620",
"label": "e",
"name": "High B1 levels",
"picture": null,
"votes": 14
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient is experiencing refeeding syndrome. It can occur in any patient who is malnourished and subsequently resumes feeding, however alcohol excess is a particular risk factor. Refeeding syndrome would cause low phosphate levels, not high.",
"id": "10007617",
"label": "b",
"name": "High phosphate",
"picture": null,
"votes": 30
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient is experiencing refeeding syndrome. It can occur in any patient who is malnourished and subsequently resumes feeding, however alcohol excess is a particular risk factor. Refeeding syndrome would cause hyperglycaemia, not hypoglycaemia.",
"id": "10007619",
"label": "d",
"name": "Hypoglycaemia",
"picture": null,
"votes": 52
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient is experiencing refeeding syndrome. It can occur in any patient who is malnourished and subsequently resumes feeding, however alcohol excess is a particular risk factor. Refeeding syndrome would cause low potassium levels, not high.",
"id": "10007618",
"label": "c",
"name": "High potassium",
"picture": null,
"votes": 50
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
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"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4487",
"name": "Refeeding syndrome",
"status": null,
"topic": {
"__typename": "Topic",
"id": "180",
"name": "Biochemistry",
"typeId": 7
},
"topicId": 180,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4487,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "14070",
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"question": "A 55-year-old female is admitted to the hospital after an unwitnessed fall and long lie. She has a history of alcohol excess, with poor oral intake. Since her admission to the hospital, nursing staff report she has been eating well. However, two days later, she becomes drowsy and confused.\n\nOn examination she appears pale and malnourished, with long and dirty fingernails. She is neurologically intact, with no external evidence of a head injury.\n\nWhich of the following would you expect to find on the patient’s blood results?",
"sbaAnswer": [
"a"
],
"totalVotes": 241,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,363 | false | 26 | null | 6,495,113 | null | false | [] | null | 14,071 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Irritable Bowel Syndrome is a possible differential for a patient presenting with a change in bowel habits. However, it is a diagnosis of exclusion. It is essential to first rule out other serious causes of his symptoms like colorectal cancer.",
"id": "10007623",
"label": "c",
"name": "Irritable Bowel Syndrome",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Ulcerative colitis is a possible differential for diarrhoea and blood in the stool. However, it is important to first exclude the possibility of malignancy causing his symptoms.",
"id": "10007622",
"label": "b",
"name": "Ulcerative colitis",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Malignancy would be the most important diagnosis to exclude in this case. This patient is aged over 60 and has a change in bowel habits. He therefore qualifies for a 2-week wait referral for possible colorectal cancer.",
"id": "10007621",
"label": "a",
"name": "Colorectal cancer",
"picture": null,
"votes": 228
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Coeliac Disease is a possible differential for a presentation of diarrhoea and weight loss. However, it is important to first exclude the possibility of a malignancy causing his symptoms.",
"id": "10007624",
"label": "d",
"name": "Coeliac Disease",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Gastroenteritis is a possible differential for a change in bowel habit. However, the duration of his symptoms and absence of nausea or vomiting makes this less likely.",
"id": "10007625",
"label": "e",
"name": "Gastroenteritis",
"picture": null,
"votes": 0
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
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"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3731",
"name": "Colorectal Cancer",
"status": null,
"topic": {
"__typename": "Topic",
"id": "136",
"name": "Gastroenterology",
"typeId": 7
},
"topicId": 136,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3731,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "14071",
"isLikedByMe": null,
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"question": "A 66-year-old male presents to the GP with lower abdominal pain that began 6 weeks ago. He also reports diarrhoea and has noticed some blood in his stool. He is pleased to report weight loss of around half a stone, despite no change to his diet.\n\nHis abdominal examination is normal.\n\nWhich of the following diagnoses is most important to exclude?",
"sbaAnswer": [
"a"
],
"totalVotes": 238,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,364 | false | 27 | null | 6,495,113 | null | false | [] | null | 14,072 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the most common cause of large bowel obstruction. Once the diagnosis of large bowel obstruction has been established, it would be useful to perform a CT abdomen to identify any tumours.",
"id": "10007626",
"label": "a",
"name": "Colonic tumour",
"picture": null,
"votes": 102
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is an important cause of large bowel obstruction, but not the most common cause. Strictures can occur secondary to diverticular disease or can happen in other conditions such as inflammatory bowel disease. They can also occur as a result of post-surgery as anastomosis.",
"id": "10007627",
"label": "b",
"name": "Stricture",
"picture": null,
"votes": 41
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Adhesions can cause large and small bowel obstructions. Adhesions are the most common cause of small bowel obstructions, whereas large bowel obstructions are most commonly caused by colonic malignancy.",
"id": "10007630",
"label": "e",
"name": "Adhesion",
"picture": null,
"votes": 43
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Hernias can cause large bowel obstructions, but the most common cause of large bowel obstruction is a colonic tumour.",
"id": "10007629",
"label": "d",
"name": "Hernia",
"picture": null,
"votes": 15
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is an important cause of large bowel obstruction but not the most common cause. The most common cause of large bowel obstruction are colonic tumours.",
"id": "10007628",
"label": "c",
"name": "Volvulus",
"picture": null,
"votes": 42
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4611",
"name": "Large Bowel Obstruction",
"status": null,
"topic": {
"__typename": "Topic",
"id": "136",
"name": "Gastroenterology",
"typeId": 7
},
"topicId": 136,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4611,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "14072",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
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"psaSectionId": null,
"qaAnswer": null,
"question": "A 40-year-old male presents to A&E with central abdominal pain that has been increasing over the past 3-4 days. His abdomen is distended with tinkling bowel sounds, and he reports not opening his bowels for around a week. You suspect he has a large bowel obstruction.\n\nWhat is the most common cause of large bowel obstruction?",
"sbaAnswer": [
"a"
],
"totalVotes": 243,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,365 | false | 28 | null | 6,495,113 | null | false | [] | null | 14,073 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "In a female patient presenting with abdominal pain, it would be important to first do a pregnancy test to rule out ectopic pregnancy as a cause.",
"id": "10007635",
"label": "e",
"name": "CT abdomen",
"picture": null,
"votes": 32
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "When a female presents with abdominal pain, it is important to rule out an ectopic pregnancy. A pregnancy test is essential to rule this out. An ectopic pregnancy is a pregnancy that implants outside the uterus, most commonly in the fallopian tube. It presents as pelvic pain that can radiate to the shoulder, abnormal vaginal bleeding and haemodynamic instability. All of these features are seen in this patient.",
"id": "10007631",
"label": "a",
"name": "Urine hCG",
"picture": null,
"votes": 164
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This may be a useful investigation if you suspected this patient’s abdominal pain was caused by a bowel obstruction. However, as this patient's bowels have been opening normally, a bowel obstruction is less likely.",
"id": "10007632",
"label": "b",
"name": "Abdominal X ray",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "In a female patient presenting with abdominal pain it is important to rule out ectopic pregnancy as an initial cause, so a urine hCG would be the most important initial investigation.",
"id": "10007633",
"label": "c",
"name": "Ultrasound Abdomen",
"picture": null,
"votes": 29
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "It may be useful to do a urine dipstick for this patient if you suspected cystitis. However, this patient does not have any urinary frequency or dysuria, so cystitis is less likely. The right iliac fossa pain that radiates to the shoulder tip points us in the direction of an ectopic pregnancy, therefore a urine hCG would be the best initial investigation.",
"id": "10007634",
"label": "d",
"name": "Urine dipstick",
"picture": null,
"votes": 11
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4612",
"name": "Ectopic Pregnancy",
"status": null,
"topic": {
"__typename": "Topic",
"id": "176",
"name": "Gynaecology",
"typeId": 7
},
"topicId": 176,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4612,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "14073",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
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"question": "A 26-year-old female presents to A&E with abdominal pain that began 2 days ago. She says it began as an ache but has become gradually more severe. There is also pain in the tip of her shoulder. She denies any urinary frequency or dysuria. Her bowels are opening normally.\n\nOn examination, her heart rate is 94 and her blood pressure 100/72. She appears clammy and pale.\n\nWhich of the following is the most important initial investigation?",
"sbaAnswer": [
"a"
],
"totalVotes": 244,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,366 | false | 29 | null | 6,495,113 | null | false | [] | null | 14,074 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "These type of renal stones are radio-lucent, meaning they are often not visible on X-ray, ultrasound or CT scans.",
"id": "10007639",
"label": "d",
"name": "Indinavir",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. The patient has severe intermittent loin to groin pain, which suggests a diagnosis of renal stones. A past medical history of gout makes uric acid the most likely composition of these stones.",
"id": "10007636",
"label": "a",
"name": "Uric acid",
"picture": null,
"votes": 195
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This type of renal stone occurs in patients with homocystinuria, an autosomal recessive inherited disorder that predisposes individuals to recurrent renal stones and urinary tract infections. This patient is more likely to have uric acid renal stones, as they have a past medical history of gout.",
"id": "10007637",
"label": "b",
"name": "Cysteine",
"picture": null,
"votes": 17
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This type of renal stone often results in large, staghorn calculi. They are more likely to occur if the patient has recurrent upper urinary tract infections.",
"id": "10007638",
"label": "c",
"name": "Struvite",
"picture": null,
"votes": 27
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Magnesium is not a significant component of most renal stones.",
"id": "10007640",
"label": "e",
"name": "Magnesium",
"picture": null,
"votes": 2
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4413",
"name": "Renal Stones",
"status": null,
"topic": {
"__typename": "Topic",
"id": "142",
"name": "Nephrology",
"typeId": 7
},
"topicId": 142,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4413,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "14074",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
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"question": "A 31-year-old female presents to A&E with severe lower abdominal pain that began earlier in the day. She describes it as a colicky pain. She has begun vomiting and noticed small amounts of blood in her urine. She has a past medical history of gout, hypertension, hypothyroidism and GORD.\n\nYou suspect she has renal stones.\n\nWhich of the following is the most likely composition of this patient's renal stone?",
"sbaAnswer": [
"a"
],
"totalVotes": 241,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,367 | false | 30 | null | 6,495,113 | null | false | [] | null | 14,075 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This would not be a first-choice antimicrobial for cystitis. Instead, a course of trimethoprim would be the most appropriate management.",
"id": "10007644",
"label": "d",
"name": "Clindamycin",
"picture": null,
"votes": 51
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient has typical symptoms of cystitis. Intravenous cephalosporin would be an appropriate management option if the patent had pyelonephritis. This would be suspected if they presented with pyrexia and loin or flank tenderness.",
"id": "10007642",
"label": "b",
"name": "IV cephalosporin",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This would not be first line in a presentation of cystitis. You may choose to use pivmecillinam as a second choice antibiotic if there is no improvement with a first choice antimicrobial or if a first choice isn’t suitable.",
"id": "10007643",
"label": "c",
"name": "Pivmecillinam",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This would not be a first-choice antimicrobial for cystitis. You may choose to use fosfomycin as a second choice antimicrobial if trimethoprim were ineffective.",
"id": "10007645",
"label": "e",
"name": "Fosfomycin",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the antibiotic treatment for suspected cystitis. This patient presents with urinary frequency, dysuria, urgency, foul-smelling urine, and suprapubic pain, all consistent with cystitis. Trimethoprim is therefore the most appropriate management option.",
"id": "10007641",
"label": "a",
"name": "Trimethoprim",
"picture": null,
"votes": 174
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4613",
"name": "Urinary tract infection",
"status": null,
"topic": {
"__typename": "Topic",
"id": "162",
"name": "General practice",
"typeId": 5
},
"topicId": 162,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4613,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "14075",
"isLikedByMe": null,
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"likes": 0,
"multiAnswer": null,
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"question": "An 18-year-old female presents to the GP with an increased urinary frequency for the past 10 days. She also reports some dysuria and pain in the suprapubic region. A urine dipstick is positive for leucocytes and nitrites.\n\nHer observations are all within the normal range, and she is keen to get back to her university studies as soon as possible.\n\nWhich of the following is the most appropriate antimicrobial management?",
"sbaAnswer": [
"a"
],
"totalVotes": 238,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,368 | false | 31 | null | 6,495,113 | null | false | [] | null | 14,076 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Nicorandil is used as a vasodilatory drug in the treatment of angina. It does not cause hyperkalaemia but can, however, have a range of other side effects including: headaches, flushing, and skin and eye ulceration.",
"id": "10007647",
"label": "b",
"name": "Nicorandil",
"picture": null,
"votes": 13
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "ACE inhibitors work by inhibiting the conversion of angiotensin I to angiotensin II, preventing the secretion of aldosterone. Aldosterone usually acts to cause sodium reabsorption and consequently, secretion of potassium into the urine. Inhibition of this process through an ACE inhibitor can therefore lead to hyperkalaemia in some patients. Other side effects of ACE inhibitors to be aware of include: cough, angioedema, and first-dose hypotension.",
"id": "10007646",
"label": "a",
"name": "Ramipril",
"picture": null,
"votes": 150
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Statins work by inhibiting the actions of HMG-CoA reductase in the liver, which is an enzyme involved in cholesterol synthesis. Statins do not commonly cause hyperkalaemia. However, they can cause myopathy, and liver impairment and they can increase the risk of intracerebral haemorrhage in some patients.",
"id": "10007650",
"label": "e",
"name": "Atorvastatin",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Loop diuretics work by inhibiting the Na-K-Cl cotransporter in the loop of Henle, which reduces the absorption of NaCl. This means that loop diuretics cause hypokalaemia, not hyperkalaemia.",
"id": "10007648",
"label": "c",
"name": "Furosemide",
"picture": null,
"votes": 55
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Beta-blockers such as propranolol can cause a number of side effects including bronchospasm, fatigue, sleep disturbances, and erectile dysfunction. They do not commonly cause hyperkalaemia.",
"id": "10007649",
"label": "d",
"name": "Propranolol",
"picture": null,
"votes": 11
}
],
"comments": [],
"concept": {
"__typename": "Concept",
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"__typename": "Chapter",
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"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4614",
"name": "ACE-inhibitors",
"status": null,
"topic": {
"__typename": "Topic",
"id": "188",
"name": "Renal Pharmacology",
"typeId": 7
},
"topicId": 188,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
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},
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"question": "A 59-year-old male is found to have hyperkalaemia on a routine blood test. He has a past medical history of type 2 diabetes mellitus, hypertension and generalized anxiety disorder.\n\nWhich of the following medications is most likely to be causing his hyperkalaemia?",
"sbaAnswer": [
"a"
],
"totalVotes": 236,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,369 | false | 32 | null | 6,495,113 | null | false | [] | null | 14,077 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The trigone of the bladder is formed of two ureteric orifices and the internal urethral meatus.",
"id": "10007653",
"label": "c",
"name": "Ureteric orifice, internal urethral sphincter and internal urethral meatus",
"picture": null,
"votes": 39
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The trigone of the bladder is formed of two ureteric orifices and the internal urethral meatus.",
"id": "10015619",
"label": "e",
"name": "Ureteric orifice and internal urethral sphincter",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The trigone is located on the posterior wall of the bladder. It is a triangle shape and is defined by three structures: two ureteric orifices and the internal urethral meatus. It is the least mobile part of the bladder.",
"id": "10007651",
"label": "a",
"name": "Two ureteric orifices and the internal urethral meatus",
"picture": null,
"votes": 168
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The trigone of the bladder is formed of two ureteric orifices and the internal urethral meatus.",
"id": "10007654",
"label": "d",
"name": "Ureteric orifice, pubic symphysis, and internal urethral meatus",
"picture": null,
"votes": 16
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The Trigone of the bladder is formed of two ureteric orifices and the internal urethral meatus.",
"id": "10007652",
"label": "b",
"name": "Fundus and two inferolateral surfaces",
"picture": null,
"votes": 12
}
],
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"demo": null,
"entitlement": null,
"id": "4615",
"name": "Bladder cancer",
"status": null,
"topic": {
"__typename": "Topic",
"id": "143",
"name": "Urology",
"typeId": 7
},
"topicId": 143,
"totalCards": null,
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"question": "A 55-year-old female attends an oncology clinic appointment for a discussion of her newly diagnosed bladder cancer. She is keen to explore surgical treatment options.\n\nWhich of the following structures form the trigone of the bladder?",
"sbaAnswer": [
"a"
],
"totalVotes": 239,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,370 | false | 33 | null | 6,495,113 | null | false | [] | null | 14,078 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "A temporal artery biopsy is the definitive investigation for giant cell arteritis. A temporal headache, scalp tenderness, and jaw claudication are strongly indicative of giant cell arteritis. Steroid treatment should be commenced promptly to prevent visual loss.",
"id": "10007655",
"label": "a",
"name": "Temporal artery biopsy",
"picture": null,
"votes": 194
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient demonstrates a classic presentation of giant cell arteritis: temporal headache, jaw claudication, and scalp tenderness. ESR is the most sensitive test to diagnose this condition. However, the definitive investigation would be a temporal artery biopsy.",
"id": "10007657",
"label": "c",
"name": "Erythrocyte sedimentation rate (ESR)",
"picture": null,
"votes": 13
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient is presenting with symptoms of giant cell arteritis: a temporal headache, jaw claudication, and scalp tenderness. The most appropriate investigation to diagnose this condition would be a temporal artery biopsy.",
"id": "10007656",
"label": "b",
"name": "Full blood count (FBC)",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient demonstrates a classic presentation of giant cell arteritis. It may be useful to also conduct a CT head if you suspected large vessel involvement. However, you should first conduct a temporal artery biopsy as the definitive investigation for this condition.",
"id": "10007659",
"label": "e",
"name": "CT head",
"picture": null,
"votes": 32
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient demonstrates a classic presentation of giant cell arteritis. Therefore the definitive investigation is a temporal artery biopsy, not a lumbar puncture.",
"id": "10007658",
"label": "d",
"name": "Lumbar puncture",
"picture": null,
"votes": 2
}
],
"comments": [],
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},
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"demo": null,
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"id": "3853",
"name": "Giant Cell Arteritis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "146",
"name": "Rheumatology",
"typeId": 7
},
"topicId": 146,
"totalCards": null,
"typeId": null,
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"userNote": null,
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},
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"dislikes": 0,
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"id": "14078",
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"question": "A 64-year-old female presents to the GP with a headache just lateral to her left eye that began a day ago. She has also noticed some pain on chewing food and scalp tenderness on the left-hand side. She reports normal vision in both eyes.\n\nWhich of the following can definitively diagnose the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 242,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,371 | false | 34 | null | 6,495,113 | null | false | [] | null | 14,079 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a disease modifying anti-rheumatic drug (DMARD) that can be used for treatment of inflammatory conditions like rheumatoid arthritis. Its side effects include retinopathy and rash in some patients. It would not cause the symptoms that this patient is experiencing.",
"id": "10007662",
"label": "c",
"name": "Hydroxychloroquine",
"picture": null,
"votes": 19
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This can cause myelosuppression, nausea, rash, oral ulcers and a decreased sperm count. It would not be responsible of causing symptoms of dysphagia and dyspepsia.",
"id": "10007661",
"label": "b",
"name": "Sulfasalazine",
"picture": null,
"votes": 21
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Phenytoin is used for the management of status epilepticus. It has a range of side effects that include: acne, anorexia, constipation, paraesthesia, rashes, and tremors. It would not cause dysphagia and dyspepsia.",
"id": "10007664",
"label": "e",
"name": "Phenytoin",
"picture": null,
"votes": 11
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Amiodarone can be used for management of atrial fibrillation and cardiac arrhythmias. Its side effects can include hypo- or hyperthyroidism as well as corneal deposits, grey skin discolouration, and occasionally liver failure. It would not cause this patient’s presentation.",
"id": "10007663",
"label": "d",
"name": "Amiodarone",
"picture": null,
"votes": 14
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Bisphosphonates like alendronic acid can cause oesophagitis, oesophageal ulcers, dysphagia and dyspepsia. To reduce the risk of these side effects occurring, there are specific guidelines that patients can follow. These include: taking tablets on an empty stomach 30 minutes before food, sitting upright for 30 minutes after taking the medication, and swallowing tablets whole with plenty of water.",
"id": "10007660",
"label": "a",
"name": "Alendronic acid",
"picture": null,
"votes": 177
}
],
"comments": [],
"concept": {
"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4616",
"name": "Osteoporosis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "170",
"name": "Clinical Chemistry",
"typeId": 7
},
"topicId": 170,
"totalCards": null,
"typeId": null,
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},
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"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "14079",
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"question": "A 59-year-old female attends the GP with a 10-day history of upper abdominal pain. She also reports having some difficulty swallowing and a burning sensation in the middle of her chest.\n\nShe has no other medical conditions aside from hay fever and osteoporosis.\n\nWhich of the following medications is the most likely cause of her symptoms?",
"sbaAnswer": [
"a"
],
"totalVotes": 242,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,372 | false | 35 | null | 6,495,113 | null | false | [] | null | 14,080 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This would typically cause shoulder and hip girdle stiffness alongside systemic symptoms such as fever, anorexia, weight loss and malaise. ESR and CRP are typically raised, as this is an inflammatory condition. Polymyalgia rheumatica would not account for the raised ALP seen in this patient.",
"id": "10007667",
"label": "c",
"name": "Polymyalgia Rheumatica",
"picture": null,
"votes": 34
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This would present as inflammation and pain in one joint, most commonly the wrist or shoulder. It would not account for this patient’s high ALP.",
"id": "10007669",
"label": "e",
"name": "Pseudogout",
"picture": null,
"votes": 14
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Gout typically presents with a red, hot and swollen joint. It would not account for the raised ALP, so is not the most likely diagnosis in this case.",
"id": "10007668",
"label": "d",
"name": "Gout",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient is presenting with bone pain and an isolated raised ALP which points us to the diagnosis of Paget’s disease. Paget’s disease can also be picked up on X ray where you may find osteolysis, increased bone size and sclerosis or pathological fractures.",
"id": "10007665",
"label": "a",
"name": "Paget’s disease",
"picture": null,
"votes": 162
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Osteoporosis would have a normal bone profile, so would not explain this patient’s raised ALP.",
"id": "10007666",
"label": "b",
"name": "Osteoporosis",
"picture": null,
"votes": 26
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
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},
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"demo": null,
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"id": "4617",
"name": "Paget's Disease",
"status": null,
"topic": {
"__typename": "Topic",
"id": "170",
"name": "Clinical Chemistry",
"typeId": 7
},
"topicId": 170,
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"question": "A 20-year-old female presents to the GP with bone pain that began 6 months ago. The GP conducts some blood tests which come back as follows: normal serum calcium, normal serum phosphate, normal PTH, and high ALP.\n\nWhich of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 241,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,373 | false | 36 | null | 6,495,113 | null | false | [] | null | 14,081 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "You may wish to give an NSAID with gastric protection if you suspected this back pain was mechanical. However, this patient has some red flags, like saddle anesthesia and bowel disturbance and therefore this would not be the most appropriate action.",
"id": "10007671",
"label": "b",
"name": "Ibuprofen and omeprazole",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "It may be appropriate to look at inflammatory markers if you suspect an inflammatory cause of back pain such as ankylosing spondylitis. This would present as back pain with early morning stiffness, peripheral enthesitis or arthritis and tenderness of the sacroiliac joints. It would not cause saddle anesthesia or bowel disturbance.",
"id": "10007672",
"label": "c",
"name": "Measure ESR and CRP",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "You wish to do an X-ray of the spine if you suspect a vertebral fracture. This would be more likely if there was a history of trauma, such as involvement in a road traffic collision. However, the clinical picture here is more likely to be cauda equina syndrome, and therefore a full spine MRI is the best investigation.",
"id": "10007673",
"label": "d",
"name": "Spinal X-ray",
"picture": null,
"votes": 20
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient is presenting with the clinical features of cauda equina syndrome. Back pain associated with saddle anaesthesia (inability to feel toilet paper when wiping), and bladder or bowel disturbance (constipation or incontinence). Patients with these symptoms should receive a full spine MRI. If evidence of cauda equina is found, surgical decompression of the spine should be performed where appropriate within 48 hours of presentation.",
"id": "10007670",
"label": "a",
"name": "Whole spine MRI",
"picture": null,
"votes": 218
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This acute nature of this patient's pain and neurological changes makes a diagnosis of cauda equina more likely than multiple myeloma. Therefore, a myeloma screen would not be the best investigation for this patient.",
"id": "10007674",
"label": "e",
"name": "Myeloma screen",
"picture": null,
"votes": 2
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4618",
"name": "Cauda equina",
"status": null,
"topic": {
"__typename": "Topic",
"id": "145",
"name": "Orthopaedics",
"typeId": 7
},
"topicId": 145,
"totalCards": null,
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"id": "14081",
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"question": "A 62-year-old female presents to the GP with lower back pain that began 11 hours ago. On further questioning, she tells you she cannot feel the toilet paper when wiping. She has not opened her bowels or urinated since yesterday afternoon.\n\nWhich of the following is the next best step?",
"sbaAnswer": [
"a"
],
"totalVotes": 243,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,374 | false | 37 | null | 6,495,113 | null | false | [] | null | 14,082 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is a typical presentation of cluster headaches. The question describes a unilateral headache, worse around the eye and occurring in episodes/clusters over time. Cluster headaches are associated with a bloodshot eye, rhinorrhoea, lid swelling, and facial flushing. Attacks typically last from 15 minutes to 3 hours.",
"id": "10007675",
"label": "a",
"name": "Cluster headaches",
"picture": null,
"votes": 190
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Tension headaches present as bilateral and non-pulsatile in nature. They are often described as feeling like a tight band around the head. Although they can be associated with tenderness of the scalp, tension headaches do not cause a painful or red and watery eye. Cluster headache is the most likely diagnosis.",
"id": "10007677",
"label": "c",
"name": "Tension headache",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Migraines typically present as a unilateral throbbing headache associated with photophobia and phonophobia. Episodes of migraine last longer than cluster headaches, typically ranging from 4-72 hours. Migraines are commonly preceded by an aura, such as visual (e.g lines zigzags) or sensory (paraesthesia) symptoms. You can also look out for migraine triggers, such as oral contraceptives or chocolate.",
"id": "10007679",
"label": "e",
"name": "Migraine",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This classically presents as a temporal headache alongside jaw claudication (pain on chewing food), scalp tenderness, and sometimes visual impairment. Examination may reveal a thickened tender temporal artery. You should also look out for a patient with symmetrical proximal muscle weakness and oligoarthritis, as giant cell arteritis is often associated with polymyalgia rheumatica.",
"id": "10007678",
"label": "d",
"name": "Giant cell arteritis",
"picture": null,
"votes": 12
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Trigeminal neuralgia presents as short episodes of sharp, stabbing pain. It affects one side of the face in the trigeminal nerve distribution. They are triggered by talking, eating, or touching the face. By contrast, the headache in this question is not described as following the trigeminal nerve distribution, and it is accompanied by autonomic symptoms more suggestive of a cluster headache.",
"id": "10007676",
"label": "b",
"name": "Trigeminal Neuralgia",
"picture": null,
"votes": 25
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3948",
"name": "Headache",
"status": null,
"topic": {
"__typename": "Topic",
"id": "141",
"name": "Neurology",
"typeId": 7
},
"topicId": 141,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3948,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "14082",
"isLikedByMe": null,
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"question": "A 30-year-old female attends the GP practice complaining of episodes of pain around her left eye and forehead. She tells you that during these episodes she gets a red and watery eye and feels 'stuffy' with a runny nose. The episodes of pain last around an hour and have occurred at random, several times during the last week. Her physical examination is unremarkable.\n\nWhich of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 243,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,375 | false | 38 | null | 6,495,113 | null | false | [] | null | 14,083 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the most common cause in neonates, so would be unlikely to be the cause of this 20 year old’s meningitis. The rash described is more typical of Neisseria meningitis, rather than Group B streptococcus.",
"id": "10007683",
"label": "d",
"name": "Group B Streptococcus",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This would cause a viral meningitis, meaning the cerebral fluid analysis would show a high glucose and low protein content. By contrast, this patient is presenting with meningococcal septicaemia. Neisseria meningitidis is the most likely causative organism.",
"id": "10007681",
"label": "b",
"name": "Coxsackie Virus A",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This would cause a viral meningitis, meaning the cerebral spinal fluid would show a high glucose and low protein. By contrast, this patient is presenting with meningococcal septicaemia. Neisseria meningitidis is the most likely causative organism.",
"id": "10007682",
"label": "c",
"name": "Herpes simplex virus 2",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient is presenting with meningococcal septicaemia. Neisseria meningitidis is the most likely causative organism. Typical features include fever, headache, neck stiffness, and photophobia. The presence of a non-blanching rash indicates the infection has spread into the bloodstream.",
"id": "10007680",
"label": "a",
"name": "Neisseria Meningitidis",
"picture": null,
"votes": 226
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is cause found in immunosuppressed patients and often found in patients at the extremes of age, like newborns or the elderly. The non-blanching rash in the question is more likely to be caused by neisseria meningitis.",
"id": "10007684",
"label": "e",
"name": "Listeria monocytogenes",
"picture": null,
"votes": 1
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
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"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4619",
"name": "Meningitis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "162",
"name": "General practice",
"typeId": 5
},
"topicId": 162,
"totalCards": null,
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"question": "A 20-year-old university student is bought into A&E after being found collapsed at home. The previous day she had complained of a headache and neck stiffness. On examination, there is a purpuric rash across her abdomen that does not disappear when pressure is applied.\n\nA lumbar puncture is conducted. Cerebral spinal fluid analysis shows low levels of glucose, high white cell counts, and high protein levels.\n\nWhich of the following is the most likely causative organism?",
"sbaAnswer": [
"a"
],
"totalVotes": 242,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,376 | false | 39 | null | 6,495,113 | null | false | [] | null | 14,084 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient has a GCS of 8, not 5. He opens his eyes to pain, scoring a 2 for eye-opening response. He is making incomprehensible sounds, meaning he scored a 2 for a verbal response. He flexes to withdraw from pain, meaning he scores a 4 in motor response.",
"id": "10007687",
"label": "c",
"name": "5",
"picture": null,
"votes": 21
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient has a GCS of 8, not 4. He opens his eyes to pain, scoring a 2 for eye-opening response. He is making incomprehensible sounds, meaning he scored a 2 for a verbal response. He flexes to withdraw from pain, meaning he scores a 4 in motor response.",
"id": "10007686",
"label": "b",
"name": "4",
"picture": null,
"votes": 12
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient has a GCS of 8, not 7. He opens his eyes to pain, scoring a 2 for eye-opening response. He is making incomprehensible sounds, meaning he scored a 2 for a verbal response. He flexes to withdraw from pain, meaning he scores a 4 in motor response.",
"id": "10007689",
"label": "e",
"name": "7",
"picture": null,
"votes": 72
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient’s GCS is 8. He opens his eyes to pain, scoring a 2 for eye-opening response. He is making incomprehensible sounds, meaning he scored a 2 for a verbal response. He flexes to withdraw from pain, meaning he scores a 4 in motor response.",
"id": "10007685",
"label": "a",
"name": "8",
"picture": null,
"votes": 97
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient has a GCS of 8, not 6. He opens his eyes to pain, scoring a 2 for eye-opening response. He is making incomprehensible sounds, meaning he scored a 2 for a verbal response. He flexes to withdraw from pain, meaning he scores a 4 in motor response.",
"id": "10007688",
"label": "d",
"name": "6",
"picture": null,
"votes": 36
}
],
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},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3827",
"name": "Glasgow Coma Scale",
"status": null,
"topic": {
"__typename": "Topic",
"id": "152",
"name": "Neuroscience",
"typeId": 7
},
"topicId": 152,
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"question": "A 21-year-old patient is brought to the emergency department following a road traffic collision. His eyes are shut but they open when you squeeze his trapezius muscles. He makes incomprehensible sounds and flexes to withdraw from pain.\n\nWhat is his Glasgow Coma Scale score?",
"sbaAnswer": [
"a"
],
"totalVotes": 238,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,377 | false | 40 | null | 6,495,113 | null | false | [] | null | 14,085 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This could be identified on an ECG as a PR interval of over 200ms. This patient has delta waves on their ECG which is suggestive of Wolff-Parkinson White syndrome.",
"id": "10007693",
"label": "d",
"name": "First degree heart Block",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Atrial fibrillation is uncoordinated contraction, which causes a heart beat of 300-600 beats per minute. An ECG would show an irregularly irregular pulse rate. This patient has delta waves on their ECG which is suggestive of Wolff-Parkinson White syndrome.",
"id": "10007694",
"label": "e",
"name": "Atrial Fibrillation",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "On ECG, 3rd degree heart block would show bradycardia and complete dissociation between the P waves and QRS complexes. This patient has delta waves on their ECG which is suggestive of Wolff-Parkinson White syndrome.",
"id": "10007692",
"label": "c",
"name": "3rd degree heart block",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Atrial flutter is caused by an aberrant macro-circuit within the right atrium. The heart can beat at up to 300 beats per minute. An ECG of atrial flutter would show a saw-tooth pattern and narrow QRS complexes. This patient has delta waves on their ECG which is suggestive of Wolff-Parkinson White syndrome.",
"id": "10007691",
"label": "b",
"name": "Atrial flutter",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This presentation is most likely to be Wolff-Parkinson White syndrome. Delta waves (which are slurred upstrokes of QRS) indicate Wolff-Parkinson White syndrome. ECGs may also show a shortened PR interval, broad QRS complex, or narrow complex tachycardia. This condition is caused by an extra accessory pathway that bypasses the AV node.",
"id": "10007690",
"label": "a",
"name": "Wolff Parkinson- White syndrome",
"picture": null,
"votes": 213
}
],
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"__typename": "Concept",
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"__typename": "Chapter",
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},
"chapterId": 2693,
"demo": null,
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"id": "3700",
"name": "Wolff-Parkinson-White syndrome",
"status": null,
"topic": {
"__typename": "Topic",
"id": "134",
"name": "Cardiology",
"typeId": 7
},
"topicId": 134,
"totalCards": null,
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},
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"question": "A 19-year-old female is brought to the emergency department after a sudden collapse at home. She has no diagnosed medical conditions, but has been undergoing investigations in her GP surgery for unexplained palpitations.\n\nHer ECG demonstrates a normal sinus rhythm, with the presence of delta waves.\n\nWhich of the following is the most likely cause of her collapse?",
"sbaAnswer": [
"a"
],
"totalVotes": 234,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,378 | false | 41 | null | 6,495,113 | null | false | [] | null | 14,086 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient is experiencing a seizure called Jacksonian march. Shaking or tingling begins in one area of the body and spreads gradually up to another area. The patient does not lose consciousness during these episodes. Jacksonian march seizures are caused by electrical activity in the frontal lobe of the brain.",
"id": "10007695",
"label": "a",
"name": "Frontal Lobe",
"picture": null,
"votes": 101
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient is experiencing a seizure called Jacksonian march. Shaking or tingling begins in one area of the body and spreads gradually up to another area. They are caused by electrical activity in the frontal lobe of the brain.",
"id": "10007699",
"label": "e",
"name": "Occipital lobe",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although seizure activity has been observed in the cerebellum, focal motor dysfunction without a loss of consciousness is more typical of a frontal lobe seizure.",
"id": "10007698",
"label": "d",
"name": "Cerebellum",
"picture": null,
"votes": 46
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Parietal lobe seizures typically involve sensory symptoms such as numbness or weakness. By contrast, the Jacksonian features demonstrated by this patient are associated with a frontal lobe seizure.",
"id": "10007696",
"label": "b",
"name": "Parietal lobe",
"picture": null,
"votes": 59
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Temporal lobe seizures are associated with lip-smacking and emotional disturbances such as sudden terror or déjà vu. They can also involve auditory or olfactory hallucinations. By contrast, the Jacksonian features demonstrated by this patient are associated with a frontal lobe seizure.",
"id": "10007697",
"label": "c",
"name": "Temporal lobe",
"picture": null,
"votes": 34
}
],
"comments": [],
"concept": {
"__typename": "Concept",
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"__typename": "Chapter",
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"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3749",
"name": "Epilepsy",
"status": null,
"topic": {
"__typename": "Topic",
"id": "141",
"name": "Neurology",
"typeId": 7
},
"topicId": 141,
"totalCards": null,
"typeId": null,
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},
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"dislikes": 0,
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"id": "14086",
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"question": "A 34-year-old patient with Epilepsy has a seizure in the GP waiting room. She begins to shake in one finger, before the shaking travels up her arm. She does not lose consciousness during this episode.\n\nIn which of the following brain regions is her seizure likely to originate?",
"sbaAnswer": [
"a"
],
"totalVotes": 242,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,379 | false | 42 | null | 6,495,113 | null | false | [] | null | 14,087 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The suprachiasmatic nucleus controls the circadian rhythm, meaning it controls the regulation of sleep across 24 hours. Circadian rhythm is affected by both light and melatonin. It does not control REM atonia.",
"id": "10007701",
"label": "b",
"name": "Suprachiasmatic nucleus",
"picture": null,
"votes": 65
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This structure stabilizes the sleep wake switch. It does not control REM atonia during sleep states.",
"id": "10007704",
"label": "e",
"name": "Hypothalamic orexin",
"picture": null,
"votes": 20
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This structure inhibits the ascending arousal system during sleep. It does not control REM atonia.",
"id": "10007703",
"label": "d",
"name": "Ventrolateral preorbital nucleus",
"picture": null,
"votes": 66
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This structure is located in the brainstem and controls REM atonia, thus causing you to be paralyzed in sleep.",
"id": "10007700",
"label": "a",
"name": "Locus Coeruleus",
"picture": null,
"votes": 73
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is an excitatory neurotransmitter that interacts with nuclei in the midbrain during sleep. It does not control REM atonia.",
"id": "10007702",
"label": "c",
"name": "Hypocretin",
"picture": null,
"votes": 10
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4310",
"name": "Phases of sleep",
"status": null,
"topic": {
"__typename": "Topic",
"id": "152",
"name": "Neuroscience",
"typeId": 7
},
"topicId": 152,
"totalCards": null,
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},
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"conditions": [],
"difficulty": 1,
"dislikes": 1,
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"highlights": [],
"id": "14087",
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"question": "A 22-year-old female attends her GP surgery after experiencing a frightening episode of sleep paralysis. She recalls being asleep but unable to move her body.\n\nWhich part of the brain controls REM atonia?",
"sbaAnswer": [
"a"
],
"totalVotes": 234,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,380 | false | 43 | null | 6,495,113 | null | false | [] | null | 14,088 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient is currently taking the maximum dose of Amlodipine (10mg) and therefore you cannot increase the dose further. He therefore requires the addition of a second agent to control their blood pressure; in this case, losartan.",
"id": "10007707",
"label": "c",
"name": "Increase dose of Amlodipine",
"picture": null,
"votes": 17
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Spironolactone is used as a 4th step in hypertension management, where serum potassium is below 4.5mmol/l. The patient in this question is taking amlodipine only, therefore requires a second agent to control blood pressure. In this case, the best second step is losartan.",
"id": "10007708",
"label": "d",
"name": "Add Spironolactone",
"picture": null,
"votes": 29
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient requires an additional treatment as their blood pressure is not controlled (i.e under 140/90 in clinic) with amlodipine alone. Patients of African-Caribbean origin already taking a calcium channel blocker, who require a second agent, should be given an angiotensin receptor blocker rather than an ACE inhibitor. Therefore, losartan should be given to this patient.",
"id": "10007706",
"label": "b",
"name": "Add Ramipril",
"picture": null,
"votes": 101
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A beta blocker like bisoprolol is used as a 4th step treatment in hypertension. It is used if potassium is over 4.5mmol/l. The patient in this question is taking amlodipine only, therefore requires a second agent to control blood pressure. In this case, the best second step is losartan.",
"id": "10007709",
"label": "e",
"name": "Add Bisoprolol",
"picture": null,
"votes": 21
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient requires an additional treatment as their blood pressure is not controlled (i.e under 140/90 in clinic) with amlodipine alone. Patients of African-Caribbean origin already taking a calcium channel blocker, who require a second agent, should be given an angiotensin receptor blocker rather than an ACE inhibitor. Therefore, losartan should be given to this patient.",
"id": "10007705",
"label": "a",
"name": "Add Losartan",
"picture": null,
"votes": 69
}
],
"comments": [
{
"__typename": "QuestionComment",
"comment": "I think the latest guideline reveals CCB + ACEi or ARB or thiazide if CCB doesn't work.",
"createdAt": 1685364108,
"dislikes": 0,
"id": "27002",
"isLikedByMe": 0,
"likes": 1,
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"questionId": 14088,
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"__typename": "User",
"accessLevel": "subscriber",
"displayName": "Bladder Kinin",
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},
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"demo": null,
"entitlement": null,
"id": "3701",
"name": "Hypertension",
"status": null,
"topic": {
"__typename": "Topic",
"id": "134",
"name": "Cardiology",
"typeId": 7
},
"topicId": 134,
"totalCards": null,
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"question": "A 66-year-old male attends the GP for a blood pressure review. He is of African-Caribbean origin and is currently taking amlodipine (10mg). His blood pressure reading comes back as 144/95.\n\nWhich of the following is the most appropriate next step?",
"sbaAnswer": [
"a"
],
"totalVotes": 237,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,381 | false | 44 | null | 6,495,113 | null | false | [] | null | 14,089 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Metabolic alkalosis is caused by either retention of base or loss of acid. Its causes include vomiting, diuretics, diarrhoea, primary hyperaldosteronism, Cushing’s syndrome or massive transfusion. By contrast, a paracetamol overdose usually results in metabolic acidosis.",
"id": "10007711",
"label": "b",
"name": "Metabolic alkalosis",
"picture": null,
"votes": 38
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Paracetamol overdose can result in severe metabolic acidosis. On an arterial blood gas, this would mean a low pH, low bicarbonate and low carbon dioxide levels (particularly if the patient were compensating by hyperventilation).",
"id": "10007710",
"label": "a",
"name": "Metabolic acidosis",
"picture": null,
"votes": 145
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is caused by hypoventilation or impaired transfer of gas across alveolar membranes. Common causes of respiratory acidosis include opiate overdose, neuromuscular disorders, exhaustion or airway obstruction. By contrast, a paracetamol overdose usually results in metabolic acidosis.",
"id": "10007713",
"label": "d",
"name": "Respiratory acidosis",
"picture": null,
"votes": 15
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Lactic acidosis occurs when there is an increased lactate in the blood stream. It is caused by tissue hypoxia (shock, limb ischemia, severe anaemia) or abnormalities in metabolism of lactate (diabetic ketoacidosis, cancer, liver disease, metformin or aspirin). By contrast, a paracetamol overdose usually results in metabolic acidosis.",
"id": "10007714",
"label": "e",
"name": "Lactic acidosis",
"picture": null,
"votes": 34
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Respiratory alkalosis is caused by hyperventilation. It would happen as a result of things like CNS infections, subarachnoid haemorrhage, aspirin overdose, anaemia or panic attacks. By contrast, a paracetamol overdose usually results in metabolic acidosis.",
"id": "10007712",
"label": "c",
"name": "Respiratory alkalosis",
"picture": null,
"votes": 9
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4620",
"name": "Paracetamol Overdose",
"status": null,
"topic": {
"__typename": "Topic",
"id": "161",
"name": "Emergency Medicine",
"typeId": 5
},
"topicId": 161,
"totalCards": null,
"typeId": null,
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"userNote": null,
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},
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"difficulty": 1,
"dislikes": 0,
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"highlights": [],
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"question": "A 26-year-old female is brought into A&E after taking an overdose of Paracetamol.\n\nWhich of the following acid base disorders is most likely to be found in this patient?",
"sbaAnswer": [
"a"
],
"totalVotes": 241,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,382 | false | 45 | null | 6,495,113 | null | false | [] | null | 14,090 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This would be an appropriate investigation if a pulmonary embolism is suspected in a patient with renal impairment, contrast allergy or who is pregnant. This patient has high clinical suspicion of a DVT, not a PE, and therefore V/Q scan is not the correct answer.",
"id": "10007716",
"label": "b",
"name": "V/Q scan",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the investigation of choice when DVT is suspected. This patient has a high clinical suspicion of DVT, therefore they do not need to have a D-Dimer measured first.",
"id": "10007715",
"label": "a",
"name": "Doppler ultrasound",
"picture": null,
"votes": 145
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A D-dimer is used in patients where there is a low clinical suspicion of DVT. This patient is presenting with a unilateral swollen, erythematous lower limb after recent surgery, which means there is a high clinical suspicion of DVT. Therefore, a D-dimer is not necessary.",
"id": "10007718",
"label": "d",
"name": "D-dimer",
"picture": null,
"votes": 62
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is used in the treatment of massive DVTs. The most appropriate investigation for this patient would be to perform a Doppler ultrasound, to first identify whether a DVT is present.",
"id": "10007719",
"label": "e",
"name": "Percutaneous mechanical thrombectomy",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the diagnostic investigation for pulmonary embolism, not DVT.",
"id": "10007717",
"label": "c",
"name": "CT pulmonary angiogram",
"picture": null,
"votes": 24
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
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"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4621",
"name": "Deep Vein Thrombosis (DVT)",
"status": null,
"topic": {
"__typename": "Topic",
"id": "157",
"name": "Haematology",
"typeId": 7
},
"topicId": 157,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
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"conditions": [],
"difficulty": 1,
"dislikes": 0,
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"question": "A 33-year-old woman is reviewed on the orthopaedic ward. She underwent foot surgery 3 days ago, and has been struggling to mobilise ever since. Now she reports a painful and swollen left calf.\n\nOn examination, her left calf is noticeably swollen compared to the right. It appears erythematous, and is tender on palpation. Both lower limbs are peripherally warm and well-perfused with strong peripheral pulses.\n\nWhich of the following is the next best investigation?",
"sbaAnswer": [
"a"
],
"totalVotes": 239,
"typeId": 1,
"userPoint": null
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173,463,383 | false | 46 | null | 6,495,113 | null | false | [] | null | 14,091 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Malaria is accompanied by symptoms such as fevers, headaches, muscle aches, and tiredness. It is not specifically associated with right upper quadrant pain or jaundice.",
"id": "10007723",
"label": "d",
"name": "Malaria",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Acute infections with schistosomiasis cause itching, fevers, urticaria, arthralgia, cough, and diarrhoea. It would not explain this patient’s jaundice.",
"id": "10007722",
"label": "c",
"name": "Schistosomiasis",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Hepatitis B is a blood borne viral infection that can be transmitted by sexual contact, contaminated needles, and blood products. The patient has also travelled to an area of high prevalence which makes hepatitis B more likely.",
"id": "10007720",
"label": "a",
"name": "Hepatitis B",
"picture": null,
"votes": 198
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is an autosomal recessive condition that causes raised unconjugated bilirubin. It causes episodes of jaundice in response to stress, fasting, infection, or exercise. It does not cause abdominal pain. This, in combination with the acute history and risk factors for hepatitis, makes Gilbert's syndrome an incorrect option.",
"id": "10007721",
"label": "b",
"name": "Gilbert’s syndrome",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This type of hepatitis is transmitted via a faecal-oral route. It has a longer incubation period than hepatitis A at 3-8 weeks. Hepatitis B is therefore a more likely diagnosis.",
"id": "10007724",
"label": "e",
"name": "Hepatitis E",
"picture": null,
"votes": 32
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
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"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4039",
"name": "Hepatitis viruses",
"status": null,
"topic": {
"__typename": "Topic",
"id": "136",
"name": "Gastroenterology",
"typeId": 7
},
"topicId": 136,
"totalCards": null,
"typeId": null,
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"difficulty": 1,
"dislikes": 0,
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"highlights": [],
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"question": "A 20-year-old female has recently returned from traveling around Asia. She attends the GP with pain in her right upper quadrant that has been troubling her for the last 10 days. She has also noticed some yellowing of her eyes and reports dark urine.\n\nShe drinks 1-2 units of alcohol per week and has never smoked. She admits to having unprotected sex whilst traveling.\n\nWhich of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 243,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,384 | false | 47 | null | 6,495,113 | null | false | [] | null | 14,092 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Section 5(4) allows nurses to detain a patient for up to 6 hours, if they believe they are suffering from a mental disorder. This allows more time for the patient to be assessed.",
"id": "10007725",
"label": "a",
"name": "Section 5(4)",
"picture": null,
"votes": 87
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This section can be used by police to enter private premises and remove a person to a place of safety. This can last up to 24 hours. It is not used by nurses, or in a hospital setting.",
"id": "10007728",
"label": "d",
"name": "Section 135",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A nurse would need to use section 5(4) in order to detain a person who they think is mentally unwell.",
"id": "10007727",
"label": "c",
"name": "Section 5(3)",
"picture": null,
"votes": 41
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A section 136 can be used by police to bring someone in from a public place if the police believe they are mentally unwell. This section can last up to 24hours, after which they should have a mental health act assessment. It is not used by nurses, or in a hospital setting.",
"id": "10007729",
"label": "e",
"name": "Section 136",
"picture": null,
"votes": 16
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A section 5(2) can be used by doctors to detain a patient for up to 72 hours. It is not used by nurses.",
"id": "10007726",
"label": "b",
"name": "Section 5(2)",
"picture": null,
"votes": 81
}
],
"comments": [],
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"__typename": "Chapter",
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"id": "2693",
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"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4434",
"name": "The Mental Health Act",
"status": null,
"topic": {
"__typename": "Topic",
"id": "173",
"name": "Psychiatry",
"typeId": 5
},
"topicId": 173,
"totalCards": null,
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"question": "A 25-year-old male on the surgical ward begins shouting at other patients as he believes they are trying to poison him. He has a known diagnosis of paranoid schizophrenia but unfortunately stopped taking his medication during this admission.\n\nHe becomes agitated and tries to leave the ward. The nurse believes he is suffering from a mental disorder and feels he needs to remain in hospital for an assessment.\n\nWhich of the following sections of the mental health act can be used by nurses for this purpose?",
"sbaAnswer": [
"a"
],
"totalVotes": 234,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,385 | false | 48 | null | 6,495,113 | null | false | [] | null | 14,093 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Clozapine is associated with a risk of agranulocytosis. It is therefore important to closely monitor white cell counts in these patients.",
"id": "10007730",
"label": "a",
"name": "Agranulocytosis",
"picture": null,
"votes": 75
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Dystonia is most associated with first generation antipsychotics like haloperidol. It does not commonly occur as a result of clozapine, a second generation antipsychotic.",
"id": "10007732",
"label": "c",
"name": "Dystonia",
"picture": null,
"votes": 64
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Akathisia is associated with first generation antipsychotics like haloperidol. It is less commonly associated with clozapine, which is a second generation antipsychotic.",
"id": "10007731",
"label": "b",
"name": "Akathisia",
"picture": null,
"votes": 61
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Both first and second generation antipsychotics result in a reduction of seizure threshold, not an increased seizure threshold.",
"id": "10007734",
"label": "e",
"name": "Increased seizure threshold",
"picture": null,
"votes": 21
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Clozapine is associated with weight gain, rather than weight loss. Other prominent side effects include worsening glycaemic control and dyslipidaemia.",
"id": "10007733",
"label": "d",
"name": "Weight loss",
"picture": null,
"votes": 16
}
],
"comments": [
{
"__typename": "QuestionComment",
"comment": "thought it was a rare side effecT?\n",
"createdAt": 1696254589,
"dislikes": 0,
"id": "32078",
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"likes": 0,
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"questionId": 14093,
"replies": [],
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"__typename": "User",
"accessLevel": "subscriber",
"displayName": "NICU Serotonin",
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"demo": null,
"entitlement": null,
"id": "3828",
"name": "Side effects of antipsychotics",
"status": null,
"topic": {
"__typename": "Topic",
"id": "173",
"name": "Psychiatry",
"typeId": 5
},
"topicId": 173,
"totalCards": null,
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"question": "A 33-year-old male with a known diagnosis of schizophrenia is commenced on clozapine by his Psychiatrist.\n\nWhich of the following side effects is he most likely to experience?",
"sbaAnswer": [
"a"
],
"totalVotes": 237,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,386 | false | 49 | null | 6,495,113 | null | false | [] | null | 14,094 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Emotionally unstable personality disorder (EUPD) is characterized by abrupt mood swings, unstable relationships and instability in self image. Relationships go from idealization to devaluation. Self harm is common.",
"id": "10007735",
"label": "a",
"name": "Emotionally Unstable Personality Disorder",
"picture": null,
"votes": 183
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Schizotypal personality disorder is characterized by bizarre or magical thinking which often means patients have difficulty interacting socially. By contrast this patient demonstrates mood swings, unstable relationships and self harm, but no bizarre or magical thinking. Emotionally unstable personality disorder (EUPD) is therefore a more likely diagnosis.",
"id": "10007736",
"label": "b",
"name": "Schizotypal personality disorder",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Histrionic personality disorder is characterized by excessive displays of emotions, and will often involve behaviour that is sexually inappropriate. By contrast this patient demonstrates mood swings, unstable relationships and self harm, making emotionally unstable personality disorder (EUPD) is therefore a more likely diagnosis.",
"id": "10007739",
"label": "e",
"name": "Histrionic personality disorder",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is characterized by an intense need to be cared for by others. Patients often rely on other people to make decisions for them, and have an intense fear of abandonment. By contrast this patient demonstrates mood swings, unstable relationships and self harm, making emotionally unstable personality disorder (EUPD) is therefore a more likely diagnosis.",
"id": "10007738",
"label": "d",
"name": "Dependent Personality Disorder",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Bipolar disorder can be diagnosed when a person has at least one major depressive episode and one episode of mania or hypomania. Manic episodes are characterised by elated mood or irritability, often involving people making dangerous decisions with little thought for the consequences. Although this patient does demonstrate mood swings, there is also evidence of unstable relationships and self harm. Emotionally unstable personality disorder (EUPD) is therefore a more likely diagnosis.",
"id": "10007737",
"label": "c",
"name": "Bipolar Disorder",
"picture": null,
"votes": 36
}
],
"comments": [],
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},
"chapterId": 2693,
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"id": "4622",
"name": "Class B Personality Disorders",
"status": null,
"topic": {
"__typename": "Topic",
"id": "173",
"name": "Psychiatry",
"typeId": 5
},
"topicId": 173,
"totalCards": null,
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"question": "A 30-year-old female is bought into A&E after taking a deliberate overdose of paracetamol. She says she wanted to end her life following a stressful argument with her boyfriend. This is the third time she has presented to A&E after taking an overdose for similar reasons.\n\nHer friends mention she has regular outbursts of extreme emotions, that can make it challenging for her to maintain relationships at work and at home.\n\nWhich of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 238,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,387 | false | 50 | null | 6,495,113 | null | false | [] | null | 14,095 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is associated with a worse prognosis. A sudden onset of symptoms is associated with better prognosis in those with schizophrenia.",
"id": "10007741",
"label": "b",
"name": "Gradual onset",
"picture": null,
"votes": 45
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. Individuals with a higher IQ are more likely to have a better prognosis of schizophrenia than those with a lower IQ.",
"id": "10007740",
"label": "a",
"name": "High IQ",
"picture": null,
"votes": 90
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Having a strong support network is associated with better prognosis in those with schizophrenia.",
"id": "10007744",
"label": "e",
"name": "No support network",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "An obvious precipitating factor, such as a traumatic life event before the onset of schizophrenia, is associated with better prognosis in those with schizophrenia.",
"id": "10007743",
"label": "d",
"name": "No obvious precipitating factor",
"picture": null,
"votes": 27
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Schizophrenia that features primarily positive symptoms is associated with a better prognosis, compared to when negative symptoms predominate. Positive symptoms of schizophrenia include hallucinations, delusions, and thought disorders such as thought insertion/withdrawal and delusions. Negative symptoms include alogia (poverty of speech), anhedonia (inability to derive pleasure), incongruity and avolition (poor motivation).",
"id": "10007742",
"label": "c",
"name": "Negative symptom predominant",
"picture": null,
"votes": 70
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"typeId": 7
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"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3972",
"name": "Schizophrenia",
"status": null,
"topic": {
"__typename": "Topic",
"id": "173",
"name": "Psychiatry",
"typeId": 5
},
"topicId": 173,
"totalCards": null,
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"dislikes": 1,
"explanation": null,
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"id": "14095",
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"question": "A 20-year-old male presents to his GP with his mother. She is worried about a change in his behaviour, and describes him spending a lot of time of his own recently. On further questioning, the patient admits to hearing voices that comment on his actions throughout the day. The GP suspects a diagnosis of schizophrenia.\n\nWhich of the following factors is associated with a better prognosis of this condition?",
"sbaAnswer": [
"a"
],
"totalVotes": 236,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,463,569 | false | 1 | null | 6,495,122 | null | false | [] | null | 14,096 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The upper anterior thigh and lateral thigh corresponds to the L2 dermatome. If the patient had reduced sensation in this area we would expect it to be associated with weakness in the L2 myotome which is hip flexion. This is not the pattern of motor dysfunction seen.",
"id": "10007749",
"label": "e",
"name": "Upper anterior thigh and lateral thigh",
"picture": null,
"votes": 20
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The lateral calf correspond to the L5 dermatome. If the patient had reduced sensation in this area we would expect it to be associated with weakness in the L5 myotome which is great toe extension. This is not the pattern of motor dysfunction seen.",
"id": "10007748",
"label": "d",
"name": "Lateral calf",
"picture": null,
"votes": 25
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient has experienced a paracentral disc herniation, where the traversing nerve root (the spinal nerve root which exits below the level of the intervertebral disc) is compressed. On examination, the patient is found to have weakness of ankle plantarflexion, which corresponds to the S1 myotome. This suggests compression of the S1 spinal nerve route. Since spinal nerves carry general sensory information from the upper limb, the patient is likely to have reduced sensation of the S1 dermatome. This corresponds to the lateral border of the foot and the sole of the foot.",
"id": "10007745",
"label": "a",
"name": "Lateral border and sole of the foot",
"picture": null,
"votes": 110
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The medial leg and medial ankle correspond to the L4 dermatome. If the patient had reduced sensation in this area, the patient would have weakness in the L4 myotome which is ankle dorsiflexion.",
"id": "10007746",
"label": "b",
"name": "Medial calf and medial ankle",
"picture": null,
"votes": 53
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The anterior knee and medial thigh corresponds to the L3 dermatome. If the patient had reduced sensation in this area we would expect it to be associated with weakness in the L3 myotome which is knee extension. This is not the pattern of motor dysfunction seen.",
"id": "10007747",
"label": "c",
"name": "Anterior knee and medial thigh",
"picture": null,
"votes": 12
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
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"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3780",
"name": "Dermatomes",
"status": null,
"topic": {
"__typename": "Topic",
"id": "141",
"name": "Neurology",
"typeId": 7
},
"topicId": 141,
"totalCards": null,
"typeId": null,
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"pictures": [
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"__typename": "Picture",
"caption": null,
"createdAt": 1682329900,
"id": "1518",
"index": 0,
"name": "Lagehernia.png",
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"path": "images/xjp4ybzj1682329903489.jpg",
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"thumbhash": "DggKBoAES4iEeXh5d2iIiHeHUYYQZQg=",
"topic": {
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"id": "141",
"name": "Neurology",
"typeId": 7
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"topicId": 141,
"updatedAt": 1708373886
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"question": "A 55-year-old man presents to A&E with severe lower back pain. A sagittal MRI of the lumbar spine is taken, and he is diagnosed with a paracentral disc herniation of the lumbar spine [lightgallery]. On examination, the patient is found to have weakness of ankle plantarflexion on the right-hand side and reduced sensation in a specific area of the lower limb.\n\nWhich of the following regions of the lower limb would be expected to show reduced sensation?",
"sbaAnswer": [
"a"
],
"totalVotes": 220,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
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